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statement,   aii<a  hhuia   «ihi  auiJ3i.<xin.icx.L    iiinjiiiicn.n^iij    oiiitiuiv^ 

for  the  guidance  of  grown-up  people.  Each  primer  is  to 
be  the  work  of  a  specially  competent  writer ;  whib  the 
choice  of  topics  and  the  critical  supervision  will  be  in  the 
hands  of  an  able  and  responsible  committee.  The  series 
will  deal  with  the  chief  hygienic  subjects  of  vital  impor- 


tance,   and  will  form  a  cheap  and  compendious  popular 
library  of  health-manuals  for  every  household. 

As  these  little  books  are  produced  by  English  authors, 
they  are  naturally  based  very  much  upon  English  expe- 
rience, but  it  matters  little  whence  illustrations  upon  such 
subjects  are  drawn,  because  the  essential  conditions  of 
avoiding  disease  and  preserving  health  are  to  a  great  degree 
everywhere  the  same. 

Volumes  of  the  Series. 

EXERCISE     AND     TRAINING,  i    'iHE   HEART  AND  ITS    FUNC 

(Illustrated.)  |            TIONS. 

ALCOHOL:  Its  Use  AND  Abuse.  j    THE  HEAD. 

THE    HOUSE    AND     ITS    SUR-  CLOTHING  AND  DRESS. 

ROUNDINGS.  WATER. 

PREMATURE  DEATH:  Its  Pro-  THE  SKIN  and  its  TROUBLES. 

MOTION  OR  Prevention.  FATIGUE  AND  PAIN. 

PERSONAL  APPEARANCES  IN  THE  EAR  AND  HEARING. 

HEALTH     AND      DISEASE.  ,    THE  EYE  AND  VISION. 

(Illustrated.)  j    TEMPERATURE     IN    HEALTH 

BATHS  AND  BATHING.  I           AND  DISEASE. 

In  square  i6mo  volumes,  cloth,  price,  40  cents  each. 


For  sale  by  all  booksellers.  Any  volume  mailed,  post- 
paid, to  any  address  in  the  United  States,  on  receipt  of  the 
price. 

D,  APPLE  TON  &-  CO.,  Publishers, 

549  &  551  Broadway,  New  York. 


^ 


\^ 


HEALTH   PRIMERS. 

No.  8. 


HEALTH      PRIMERS. 


Volumes  already  published: 

No.  I.  EXERCISE  AND  TRAINING. 
"    2.  ALCOHOL:    ITS  USE  AND  ABUSE. 
"    3.  THE  HOUSE  AND  ITS  SURROUNDINGS. 
"    4.  PREMATURE  DEATH:    ITS  PROMOTION 
OR  PREVENTION. 

"    5.  PERSONAL    APPEARANCE    IN    HEALTH 
AND  DISEASE. 

"    6.  BATHS  AND  BATHING. 

"    7.  THE  SKIN  AND  ITS  TROUBLES. 

"    8.  THE  HEART  AND  ITS  FUNCTION. 


Square  i6mo.     Cloth.     Price,  40  cents  each. 


HEALTH  PRIMERS, 


THE  HEART 


AND 


ITS     FUNCTION. 


NEW   YORK: 

D.    APPLETON    AND    COMPANY, 

I,  3,  AND  5  BOND  STREET. 

i88l. 

rv-'  ,■  ,     a, 


HEALTH      PRIMERS. 


EDITORS. 

J.  LANGDON  DOWN,  M.  D.,  F.  R.  C.  P. 
HENRY  POWER,  M.  B.,  F.  R.  C.  S. 
J.  MORTIMER-GRANVILLE,  M.  D. 
JOHN  TWEEDY,  F.  R.  C.  S. 


CONTRIBUTORS  TO    THE  SERIES. 
W.  H.  ALLCHIN,  M.  B.  Lond.,  F.  R.  C.  P.,  F.  R.  S.  E. 
G.  W.  BALFOUR,  M.  D.,  St  And.,  F.  R.  C.  P.  Edin. 
J.  CRICHTON-BROWNE,  M.  D.,  Edin.,  LL.  D.,  F.  R.  S.  Edin. 
SIDNEY  COUPLAND,   M.  D.,  Lond.,  M.  R.  C.  P. 
JOHN  CURNOW,  M.  D.,  Lond.,  F.  R.  C.  P. 
J.  LANGDON  DOWN,  M.  D.,  Lond.,  F.  R.  C.  P. 
R.  FARQUHARSON,  M.  D.,  Edin.,  M.  R.  C.  P. 
TILBURY  FOX,  M.  D.,  Lond.,  F.  R.  C.  P. 

J.  MORTIMER-GRANVILLE,  M.  D.,  St.  And.,  F.  G.  S.,  F.  S.  S. 
W.  S.  GREENFIELD,  M.D.,  Lond.,  F.  R.  C.  P. 
C.  W.  H EATON,  F.  C.  S.,  F.  I.  C. 
HARRY  LEACH,  M.  R.  C.  P. 
G.  V.  POORE,  M.  D.,  Lend.,  F.  R.  C.  P. 
HENRY  POWER,  M.  B.,  Lond.,  F.  R.  C.  S. 
W.  L.  PURVES,  M.D.,  Edin.,  F.  R.  C.  S. 
J.  NETTEN  RADCLIFFE,  Ex-Pres.  Epidl.  Soc,  etc. 
C.  H.  RALFE,  M.  A.,  M.  D.,  Cantab.,  F.  R.  C.  P. 
S.  RINGER,  M.  D.,  Lond.,  F.  R.  C.  P. 
JOHN  TWEEDY,  F.  R.  C.  S. 
JOHN  WILLIAMS,  M.  D.,  Lond.,  F.  R.  C.  P. 


CONTENTS. 

■    «»« — 

PAGB 

Why  we  have  a  Heart .     -  5 

The  Structure  of  the  Human  Heart 10 

The  Function  of  the  Heart,  and  how  it  is  performed  25 

The  Relations  of  the  Heart  to  the  General  System  36 

How     TO     MAINTAIN     THE     INTEGRITY     OF     THE      HeART'S 

Function 53 


fr  THE 


THE  HEART  AND  ITS  FUNCTION. 


CHAPTER  I. 

WHY   WE    HAVE    A    HEART. 

Notwithstanding  the  many  millions  of  years  which  our 
world  and  race  have,  according  to  some,  already  existed, 
the  discovery  of  the  circulation  of  the  blood  is  but  a  thing 
of  yesterday..  From  some  passages  in  his  work,  "  De 
Trinitatis  Erroribus,"  published  in  1551,  Servetus  would 
seem  to  have  been  fully  aware  of  the  lesser  or  pulmo- 
nary circulation.  But  it  was  not  till  1628  that  the 
doctrine  of  the  circulation  of  the  blood  through  the 
system  generally  was  actually  published  by  Dr.  William 
Harvey,  though  indeed  he  had  taught  it  publicly  from  the 
year  1619.  It  was  not,  however,  till  1661,  more  than 
thirty  years  subsequently,  that  the  circulation  of  the 
blood  was  actually  demonstrated  by  means  of  the  micro- 
scope, by  Malpighi,  so  that  this  important  fact  has  been 
known  for  little  more  than  two  centuries. 


6  THE   HEART   AND    ITS    FUNCTION. 

The  whole  quantity  of  blood  in  the  body  has  been 
reckoned  at  about  one-fourteenth  part  of  the  weight  of 
the  body;  the  blood  in  the  body  of  a  man  weighing 
fourteen  stone  will  therefore  amount  to  one  stone,  or 
fourteen  pounds.  If  we  accept  this  as  a  probable  average 
of  the  weight  of  blood  in  the  body,  then  as  fourteen 
pounds  amount  to  224  ounces,  and  as  the  left  ventricle 
contains,  as  we  suppose^  only  3  ounces,  it  follows  that 
the  whole  blood  of  a  man  weighing  196  lbs.  passes 
through  his  left  ventricle  in  nearly  75  (74*6)  of  its 
systoles  or  contractions.  And  as  we  suppose  the  heart 
to  contract  only  70  times  in  a  minute,  then  the  whole  of 
the  blood  of  such  a  man  passes  through  his  heart  48  times 
in  one  hour,  or  1 1 5  2  times  in  one  day.  Of  course  the 
length  of  time  that  the  whole  of  the  blot)d  in  a  man 
takes  to  pass  through  his  heart  depends  upon  three 
factors, — first,  the  actual  amount  of  blood  he  possesses ; 
second,  the  size  of  his  ventricular  cavity ;  and  thirdly, 
the  rate  of  its  pulsation. 

The  actual  velocity  of  the  circulation,  the  time  that  one 
blood  globule  takes  to  circulate,  that  is,  to  return  to  the 
heart  after  leaving  it,  is  a  somewhat  different  matter,  and 
has  been  found  by  Vierordt  to  be  nearly  equal  to  the 
same  number  (27)  of  ventricular  systoles  in  all  animals. 
Of  course  the  time  actually  involved  in  these  twenty- 
seven  pulsations  varies  with  the  rate  at  which  the  heart 


THE   HEART   AND    ITS    FUNCTION.  ^ 

beats  j  but  in  man,  if  we  suppose  his  heart  to  beat  at  the 
rate  of  70  pulsations  per  minute,  it  will  be  a  trifle  over 
twenty-three  seconds.  In  man,  therefore,  one  globule 
courses  round  the  body  in  twenty-three  seconds,  and  the 
whole  mass  of  blood  completes  its  circulation  in  seventy- 
five  seconds. 

The  use  of  the  blood  is  to  supply  nourishment  to  every 
part  of  the  body,  and  to  remove  all  those  waste  matters 
which  result  from  every  act  evincing  life ;  and  the  object 
of  the  circulation  of  the  blood  is  to  bring  that  fluid  into 
contact  with  every  part,  so  that  these  ends  may  be 
thoroughly  carried  out.  The  blood  is  derived  from  the 
food,  and  consists  of  a  watery  solution  of  the  constituents 
of  the  body,  in  which  are  suspended  a  number  of  globules. 
The  greater  number  of  these  are  red  (Fig.  i),  and  give 
the  blood  its  crimson  colour  ;  the  others   (Fig.   2)   are 

Fig.  I. 

Fig.  2. 


white  or  colourless.  These  white  globules  never  in 
health  present  a  higher  proportion  to  the  red  than  i  to 
300  or  400 ;  but  the  proportion  is  often  much  less,  and 


8  THE   HEART   AND    ITS    FUNCTION. 

they  mostly  end  in  becoming  red  ones.  The  use  of  the 
red  globules  is  to  carry  oxygen  to  every  part,  and  so  to 
supply  what  is  needful  for  those  chemical  changes  which 
precede  every  manifestation  of  life.  Because  every  act 
by  which  we  exhibit  life  is  accompanied  by  the  conver- 
sion of  potential  into  kinetic  energy,  and  this  conversion 
of  one  form  of  energy  into  the  other  is  mainly  due  to  the 
oxidation  of  the  organic  constituents  of  the  body. 

Energy  is  simply  a  term  used  to  express  the  power  of 
doing  work.  Potential  energy  is  the  latent  power  of  doing 
work ;  and  is  possessed,  in  relation  to  gravity,  by  a  stone 
resting  on  the  brow  of  a  hill ;  in  relation  to  chemistry, 
by  a  mass,  say,  of  gunpowder.  If  we  give  the  stone  a 
push,  so  that  it  rolls  down  hill,  or  if  we  blow  up  the  gun- 
powder by  applying  a  lighted  match  to  it,  we  in  each  case 
convert  the  latent  or  potential  into  kinetic  energy.  We 
all  of  us  know  that  we  possess  a  certain  amount  of 
potential  energy — power  of  doing  work,  which  we  trans- 
mute into  labour  of  some  kind,  digging,  hammering,  or 
walking,  &c.  But  few  of  us  realise  that  thought  itself 
is  a  product  of  the  transformation  of  energy,  and  that  in 
merely  living,  without  doing  what  we  regard  as  any  actual 
work,  the  same  transformation  of  potential  into  kinetic 
energy  is  continually  taking  place  in  every  part  of  our 
body.  The  products  of  the  chemical  changes  upon 
which  this  depends  are  thrown  out  of  the  body  as  waste, 


THE    HEART   AND    ITS    FUNCTION.  9 

and  have  to  be  replaced  with  fresh  oxidisable  material. 
Every  living  creature  must  therefore  have  a  circulation 
of  blood,  or  nutritive  fluid,  throughout  its  body ;  and 
though  the  manner  in  which  this  circulation  is  carried 
out  is  not  the  same  in  all  animals,  it  is  based  on  the 
same  plan,  various  parts  being  added  as  the  animal  rises 
in  the  scale  of  being,  and  becomes  itself  more  complex 
in  structure.  The  simplest  kind  of  circulation  is  found 
in  the  lowest  forms  of  animal  life,  such  as  the  sea 
anemones ;  in  them  the  blood,  or  fluid  elaborated  in  the 
stomach,  simply  permeates  from  cell  to  cell ;  by-and-by 
a  system  of  canals,  or  blood-vessels,  is  added ;  and 
though  at  first,  as  in  worms,  leeches,  &c.,  these  vessels 
serve  by  their  own  contractions  to  propel  the  blood 
through  the  body,  yet  ere  long  we  find  the  contractions 
of  the  vessels  supplemented  by  the  addition  of  one  or 
more  contractile  sacs,  the  earliest  development  of  these 
being  found  in  crabs,  lobsters,  and  animals  of  that  cl^ss. 
This  pulsating  sac  is  the  first  rude  development  of  a 
heart,  an  organ  which  becomes  of  greater  importance  as 
we  rise  in  the  scale  of  being,  until  in  the  highest  classes 
of  animals  it  assumes  a  paramount  place  as  the  great 
centre  of  the  circulation. 


lO  THE   HEART   AND    ITS    FUNCTION. 

CHAPTER  II. 

THE    STRUCTURE    OF    THE    HUMAN    HEART. 

The  simple  pulsatory  sac,  which  is  the  earliest  form  of 
heart  found  in  animal  life,  is  equivalent  to  that  part 
of  the  human  heart  termed  the  ventricle,  because  it 
bellies  out  as  it  fills  with  blood,  as  an  india-rubber 
syringe  does  when  it  fills  with  water.  The  use  of  this 
pulsating  sac  is  to  assist  in  propelling  the  blood,  and  it 
acts  very  much  like  an  ordinary  india-rubber  Higginson's 
syringe ;  the  part  which  we  compress  with  the  hand  is  the 
heart — self-acting  of  course,  and  provided  with  similar 
appliances  in  the  shape  of  valves  to  prevent  regurgitation 
and  guide  the  fluid  in  its  onward  course.  The  fish  heart 
is  slightly  in  advance  of  this  simple  form  ;  it  is  still  a 
single  heart,  but  it  consists  of  two  cavities,  one  of  which 
ha%  thinner  walls  than  the  other,  and  is  termed  the  auricle, 
because  the  similar  portion  of  the  human  heart  resembles 
a  dog's  ear.  The  auricle  acts  as  a  mere  reservoir  for  the 
ventricle ;  during  the  contraction  of  the  ventricle,  and  for 
a  little  longer,  it  receives  the  blood  coming  to  the  heart 
from  the  general  system ;  it  then  contracts  and  forces  the 
blood  into  the  ventricle,  which  distributes  it  throughout 
the  whole  body,  valves  again  preventing  its  regurgitation 
into  the  auricle.     Fig.  3  is  a  representation  of  a  heart 


THE    HEART   AND    ITS    FUNCTION. 


11 


of  this  sort,  a  is  the  auricle,  and  b  the  ventricle.  Fig.  4 
is  a  diagram  of  the  circulation  carried  on  by  such  a  heart. 
a  is  the  auricle  and  b  the  ventricle,  sending  the  blood 
first  of  all  through  the  arteries  of  the  gills,  or  respiratory 
organs,     e  e  where  it  is  thoroughly  aerated,  and  then 


Fig.  3. 


Fig.  5. 


passed  on  to  the  general  system  through  the  great  artery 
/,  being  returned  to  the  auricle  through  the  great  systemic 
vein  g.  In  the  reptiles  we  have  a  heart  very  much  of  the 
same  type  as  in  the  fish,  but  provided  with  two  auricles, 
one  of  which,  b  Fig.  5,  receives  the  blood  from  the  lungs, 


12  THE   HEART   AND    ITS    FUNCTION. 

as  the  respiratory  organs  are  termed  when  contained  within 
the  chest ;  while  the  other,  c,  receives  that  from  the  general 
system.  The  blood  from  the  lungs  is  thoroughly  aerated, 
bright  scarlet,  and,  as  we  say,  arterial  in  its  character ; 
that  from  the  general  system  is  of  a  dark  purple  hue, 
venous  as  we  call  it.  Both  kinds  of  blood  are  poured 
into  the  one  ventricle  a,  which  sends  the  mixed  blood 
to  the  lungs  d  on  the  one  hand,  and  to  the  general 
system  e  on  the  other.  (In  the  diagram  the  dark  shading 
represents  the  course  of  the  venous  blood,  the  light 
that  of  the  arterial,  and  the  intermediate  that  of  the 
mixed  blood.)  In  all  these  animals  the  blood  is 
cold,  but  when  we  rise  to  the  higher  types — the  birds 
and  mammals — we  find  the  blood  warm,  and  the  whole 
organism  possessing  a  greater  energy  of  vitality,  largely 
due  to  the  circulation  through  it  of  a  more  highly  oxy- 
genated blood,  as  we  see  represented  in  Fig.  6.  Here 
we  see  one  half  entirely  light  and  the  other  wholly 
dark,  there  is  no  admixture  anywhere ;  the  very  heart  is 
doubled,  so  that  there  may  be  no  chance  of  any  mixture, 
and  we  have  a  venous  heart — auricle  and  ventricle — and 
an  arterial  heart  having  a  similar  structure,  the  lungs,  or 
aerating  organs,  lying  between  them.  Both  hearts'  are 
combined  into  one  organ,  commonly  called  the  heart,  the 
two  halves  of  which  act  together  equally  and  simul- 
taneously, except  under  certain  unusual  morbid  condi- 


THE    HEART    AND    ITS    FUNCTION.  1 3 

tions,  when  sometimes  the  one  half  and  sometimes  the 
other  may  be  found  to  predominate  alternately.  Before 
birth  the  unborn  mammal  breathes  no  air,  and  the 
structure  of  the  heart  and  blood-vessels  is  somewhat 
modified,   so  that   the   circulation   under  these   circum- 

FiG.  6. 


^'^^e^^^STEWi 


Stances  is  reptilian  in  its  character.  But  immediately 
after  birth  these  modifications  disappear,  and  the  circula- 
tion through  the  two  hearts  becomes  distinct  and  sepa- 
rate, venous  on  the  one  side— that  is,  consisting  only  of 
dark  purple  blood;   and  arterial — that  is,  having  only 


14  THE    HEART   AND    ITS    FUNCTION. 

bright  scarlet  and  freshly  oxygenated  blood — on  the  other. 
It  now  and  then  happens  that  the  modifications  in  the 
organs  of  circulation  which  exist  in  all  before  birth, 
remain  permanent  after  it ;  but  these  exceptional  infants 
have  a  low  vitality,  with  lips  and  extremities  Hvid  and 
cold,  and  they  seldom  live  long. 

The  Human  Heart  follows  the  general  type  common 
to  all  mammals,  and  every  part  of  the  following  descrip- 
tion may  be  quite  easily  followed  by  a  reference  to  the 
heart  of  an  ox  or  sheep.  The  heart  has  been  roughly 
estimated  as  about  equal  in  size  to  the  closed  fist  of  the 
person  to  whom  it  belongs ;  it  has,  like  an  egg,  a  broad 
end,  termed  its  dase,  which  is  directed  upwards,  back- 
wards, and  to  the  right;  and  a  pointed  end,  which  is 
called  its  apex,  and  is  directed  downwards,  forwards,  and 
to  the  left,  so  as  to  lie  opposite  the  interval  between  the 
fifth  and  sixth  ribs,  about  two  and  a  half  inches  from  the 
middle  of  the  breast  bone.  The  apex  is  that  part  of 
the  heart  which  is  distinctly  felt  to  strike  the  chest  wall 
when  we  lay  our  hand  over  the  left  side  of  the  chest. 

The  heart  lies  within  the  cavity  of  the  chest,  between 
the  two  lungs,  but  much  more  on  the  left  side  than  the 
right  one.  It  partly  rests  upon  the  diaphragm  or  midriff, 
that  is,  the  arched  muscular  partition  which  stretches 
across  the  body,  and  divides  the  cavity  of  the  chest  from 
that  of  the  belly,  and  is  partly  suspended  by  the  large 


THE   HEART   AND   ITS   FUNCTION.  1 5 

vessels  connected  with  it.  It  is  enclosed  within  a  sac 
termed  the  pericardium,  not  as  an  apple  is  when  actually 
within  a  bag,  but  as  if  an  apple  were  closely  enfolded  by 
a  closed  bag  being  wrapped  round  it.  In  this  way  one 
side  of  the  thin  pericardial  sac  closely  enfolds  the  heart, 
and  is  adherent  to  it,  creeping  a  short  way  up  the  roots 
of  the  large  vessels,  and  from  these  it  is  reflected  to  form 
the  other  or  outer  side  of  the  bag.  Actually  within 
the  bag  itself  there  is  only  a  little  steamy  moisture,  which 
sometimes  before  death,  and  always  after  it,  ^is  found 
condensed  as  a  yellowish  serum  or  watery  fluid ;  hence  the 
pericardium  is  called  a  serous  sac  or  bag.  It  is  easy  to 
,see  that  with  a  bag  so  constructed  surrounding  it,  the 
heart,  though  not  actually  within  the  sac,  has  yet  quite 
as  much  freedom  of  movement  as  if  it  were,  while  it  has 
the  additional  advantage  of  having  its  own  surface  care- 
fully protected  and  lubricated.  Around  the  serous  sac 
there  is  a  firm  fibrous  outer  coating,  which  is  attached 
below  to  the  central  tendon  of  the  diaphragm,  and  is  con- 
tinuous above  with  the  fibrous  sheath  of  the  great  vessels ; 
it  therefore  helps  to  support  and  to  keep  the  heart  in  its 
place. 

Within  the  pericardium  the  heart  lies  very  much  as 

it   is   represented  in  Fig.   7  ;    the   right   or   pulmonary 

heart   being   in  front  and   a   little  to  the   right  of  the 

left  or  systemic  heart.     The  heart  measures  about  five 

2 


l6  THE    HEART   AND    ITS    FUNCTION. 

inches  in  length  by  three  and  a  half  in  breadth,  and 
weighs  upon  an  average  about  ten  ounces,  the  heart  of 
a  man  weighing  about  one  ounce  more  than  this,  that 
of  a  woman  about  one  ounce  less.    (John  Reid.)     The 

Fig.  7. 


In  this  figure  the  numeral  i  is  placed  on  the  appendix  or  loose  por- 
tion of  left  auricle,  the  body  of  which  lies  behind  the  heart,  between  the 
two  lungs,  2  on  the  left  ventricle,  3  on  the  right  ventricle,  4  on  the 
right  auricle,  5  on  the  pulmonary  artery,  6  on  the  aorta,  or  large  artery 
which  conveys  from  the  heart  all  the  blood  going  to  the  body,  and  7  on 
the  vena  cava  superior,  which,  with  another  vein  not  seen,  called  the 
inferior  cava,  convey  all  the  blood  from  the  body  to  the  heart,  while  at 
each  side  the  pulmonary  veins  are  seen  passing  from  the  lungs  to  the 
body  of  the  left  auricle  which  lies  at  the  back  of  the  heart  between 
the  two  lungs. 

heart,  as  already  stated,  is  a  double  organ,  and  in 
Fig.  8  the  two  halves  of  this  organ  are  diagramatically 
represented  in  section  as  placed  side  by  side,  so  as  to 


THE  HEART  AND  ITS  FUNCTION.  I7 

exhibit  the  relation  to  each  other  of  the  four  cavities 
comprised  in  these  two  halves.  Two  of  these  cavities, 
a  and  d,  have,  as  we  see,  much  thinner  walls  than  the 
other  two,  b  and  e.  The  two  thin-walled  cavities  are 
termed  auricles  because  there  is  attached  to  the  body  of 
each  of  them  an  appendix  supposed  to  resemble  a  dog's 
ear  (auricula).  The  thick- walled  cavities  are  termed 
ventricles  because  when  full  they  swell  out  and  are  bellied. 

Fig.  8. 


These  four  cavities  are  of  nearly  equal  capacity,  the  two 
Ventricles  containing  nearly  three  fluid  ounces  each,  while 
the  auricles  scarcely  contain  so  much.  The  two  sets  of 
cavities  are  completely  separated  from  each  other  by  a 
fixed  and  solid  partition  extending  from  the  base  to  the 
apex  of  the  heart,  which  prevents  all  direct  communica- 
tion between  them.  On  the  other  hand,  the  two  cavities 
on  each  side  of  this  solid  septum  or  dividing  wall,  do 


1 8  THE   HEART   AND    ITS    FUNCTION. 

communicate  with  each  other,  being  only  separated 
transversely  by  a  movable  partition,  consisting  of  mem- 
branous valves  which  open  when  the  auricles  contract 
to  permit  the  onward  flow  of  the  blood,  and  close  when 
the  ventricles  act  to  prevent  the  blood  flowing  back  into 
the  auricles.  On  the  left  side  the  valve  consists  of  two 
segments,  and  is  called  the  bicuspid  or  mitral  valve; 
while  on  the  right  side  there  are  three  segments,  and  the 
valve  is  called  the  tricuspid.  The  cavity  above  these 
valves  on  either  side  is  the  auricle ;  the  cavity  below  them, 
the  ventricle. 

A  reference  to  the  diagram  will  also  show  that  each 
ventricle  is  provided  not  only  with  an  inlet,  as  just 
described,  but  also  with  an  outlet,  as  at  c  and^  Upon 
each  ventricular  outlet  there  is  attached  an  elastic  tube, 
these  being  respectively  the  two  great  arteries  (arterial 
trunks)  of  the  body;  ^,  the  aorta  passing  off  from  the 
left  ventricle,  and  conveying  from  it  the  blood  which  is  to 
be  distributed  throughout  the  body  for  its  nourishment ; 
and  /,  the  pulmonary  artery  coming  off  from  the  right 
ventricle,  and  carrying  to  the  lungs  the  blood  collected 
from  every  part  of  the  body  by  the  veins,  to  be  aerated, 
that  is,  to  receive  there  a  fresh  supply  of  oxygen,  without 
which,  as  we  have  already  learned,  every  manifestation 
of  life  would  cease.  At  the  outlet  of  each  ventricle 
a  valvular  apparatus  is  placed,  consisting,  each  of  them, 


THE    HEART   AND    ITS    FUNCTION.  TQ 

of  three  pouch-like  valves,  called  the  aortic  and  the  pul- 
monary semilunar  valves.  The  segments  of  each  of  these 
valves  open  outwards  to  permit  the  blood  to  flow  out,  but 
close  when  the  emptied  ventricle  recommences  to  dilate 
in  order  to  prevent  any  flow  of  the  blood  backwards 
(regurgitation). 

Fig.   9  represents   the  base  of  the  ventricular  cone, 

Fig.  9. 


•  The  segments  of  the  tricuspid  valve,  which  close  the  opening  in  the 
right  ventricle  leading  into  the  right  auricle,  are  marked  by  the  numeral  5. 
I  is  placed  on  the  base  of  the  right  ventricle,  which  terminates  in  what 
is  termed  the  cotitis  arteriosus,  leading  into  the  piilmonarj''  artery  ;  the 
numeral  7  is  placed  on  the  semilunar  valves  closing  this  opening.  The 
base  of  the  left  ventricle  is  marked  by  the  numeral  2  ;  the  segments  of 
the  mitral  valve  by  6  ;  those  of  the  aortic  semilunar  valves  are  seen 
above  8,  which  is  placed  on  the  base  of  the  aorta ;  9  points  out  the  left, 
and  q'  the  right  coronary  artery,  which  supply  the  heart  itself  with 
blood  ;  while  ^  and  4  point  out  the  remains  of  the  right  and  left  auricles 
respectively. 

with  the  four  openings  just  described,  and  the  valves 
which  guard  them  and  so  far  direct  the  blood-current  in 


20  THE    HEART   AND    ITS    FUNCTION. 

its  onward  course  by  preventing  its  flowing  in  any  other 
direction. 

A  firm  fibrous  or  tendinous  ring  surrounds  the  four 
openings  described,  and  to  it  the  valves  are  attached,  as 
well  as  the  muscular  fibres  of  the  auricles  superiorly,  and 
inferiorly  those  of  the  ventricles,  which  are  only  indirectly 
connected  with  each  other  by  means  of  this  fibrous  ring. 
The  muscular  fibres  of  the  heart  resemble  those  of  the 
voluntary  muscles  in  being  of  a  deep  red  colour  and 
marked  with  transverse  lines  (when  examined  micro- 
scopically) ;  but  they  differ  from  those  of  the  voluntary 
muscles  in  that  these  lines  (sfrice)  are  less  distinctly 
marked,  that  the  fibres  frequently  interlace,  that  they  are 
more  closely  packed  together,  and  have  but  little  inter- 
vening (loose  cellular)  connective  tissue,  that  they  are  not 
under  the  influence  of  the  will,  and  also  in  several  other 
less  important  but  not  less  distinctive  peculiarities. 

The  heart  is  almost  entirely  made  up  of  muscular  fibres, 
which  are  arranged  after  a  fashion  that  seems  sufficiently 
complex  to  the  uninitiated,  and  indeed  it  is  only  recently 
that  Dr.  Pettigrew  has  succeeded  in  so  unravelling  them 
as  to  show  the  extreme  simplicity  of  arrangement  that 
underlies  this  seeming  complexity,  and  its  singular  adap- 
tation to  the  end  in  view — the  complete  emptying  of 
the  heart  in  such  a  fashion  that  the  termination  of  its 
contraction  initiates  the  succeeding  dilatation. 


THE    HEART   AND    ITS    FUNCTION.  21 

The  interior  of  the  heart  is  lined  by  a  deHcate  mem- 
brane called  the  eiidocaj'diiuii ;  and  the  movable  par- 
titions, which  act  as  valves  at  the  four  openings  into  the 
ventricles,  are  formed  by  duplications  of  this  lining  mem- 
brane, strengthened  by  tendinous  expansions  of  the  fibrous 
rings  already  mentioned.  The  semilunar  valves,  at  the 
mouths  of  the  aorta  and  pulmonary  artery,  are  each 
composed  of  three  segments  which  flap  back  against  the 
arterial  walls  to  permit  the  escape  of  the  blood  into  the 
artery ;  but  whenever  this  is  ended,  and  the  blood  threatens 
to  return  into  the  ventricle,  now  beginning  to  dilate,  the 
three  segments  of  the  valve  fall  together  in  the  same  plane, 
and  completely  prevent  any  backward  flow.  The  valves 
between  the  auricles  and  ventricles  open  into  the  ventricles 
to  permit  the  blood  to  flow  from  the  one  to  the  other,  their 
edges  have  therefore  to  be  secured  to  prevent  them  being 
flapped  back  into  the  auricles  at  the  moment  that  the 
ventricle  contracts.  This  is  managed  by  means  of  ten- 
dinous cords  attached  to  the  free  edges  and  under  sur- 
faces of  these  valves,  the  other  ends  of  these  cords  being 
attached  to  fleshy  projections  on  the  inside  of  each  ventricle, 
called  the  columnce  caniece,  or  fleshy  columns,  which  are  part 
of  the  general  heart  muscle  detailed  for  this  special  duty. 
When  the  blood  flows  into  the  ventricle  the  segments  of 
the  valves  are  floated  up,  and  when  they  reach  a  certain 
height  ^he  tendinous  cords  come  into  action,  and  bring 


22 


THE   HEART  AND    ITS    FUNCTION. 


the  edges  of  these  segments  t(5  bear  on  one  another,  back 
to  back  as  it  were,  so  that  during  the  contraction  of  the 
ventricle  not  a  drop  can  escape  backwards  into  the 
auricles.  Figures  lo  and  ii  represent  the  right  side  of 
the  heart  in  the  two  opposite  conditions  referred  to  ;  in 
Fig.  lo  the  action  of  tendinous  cords  and  fleshy  columns 
in  closing  the  valve  is  well  seen.     The  mode  of  action  of 


Fig.  io. 


Fig.  II. 


these  valves  may  be  also  readily  seen  in  a  sheep's  heart 
which  has  had  the  auricles  cut  away,  the  aorta  and  pul- 
monary artery  tied,  and  water  then  f)Oured  into  the  ven- 
tricles BO  as  nearly  to  fill  them,  a  slight  compression  of 
the  ventricles  will  then  at  once  throw  these  valves  into 
action.  We  can  also  put  the  aortic  or  pulmonary  valves 
into  action  by  pouring  water  into  these  arteries  from 
above,  when  the  water  is  seen  not  to  escape,  *nd  the 


THE   HEART   AND    ITS   FUNCTION.  23 

closed  segments  may  be"  readily  enough  distinguished 
thfough  the  clear  water,  or  they  may  be  looked  at  from 
below  if  we  first  cut  off  the  ventricle,  when  they  will  be 
seen  bulging  downwards  with  their  edges  closely  wedged 
together  so  as  to  permit  not  a  drop  to  escape. 

Such,  then,  is  a  'concise  account  of  the  structure  of  the 
heart  itself;  but  it  would  be  of  no  use  unless  provided 
with  channels  through  which  it  could  exert  its  function 
of  sending  the  blood  destined  to  irrigate  and  feed  the 
tissues  which  make  up  the  body.  To  this  end  we  have 
connected  with  the  heart  a  system  of  vessels  through 
which  the  blood  is  conveyed,  part  of  them  distributing  it 
throughout  the  body  generally,  and  part  carrying  it  to 
the  lungs  for  the  purpose  of  having  it  aerated. 

The  aorta  (6  Fig.  7,  p.  16)  springs  from  the  left  ventricle 
and  distributes  the  scarlet  arterial  or  oxygenated  blood 
throughout  the  body.  The  blood  returns  to  the  right 
auricle  through  the  veins  of  a  dark  purple,  or,  as  it  is 
called,  venous  hue,  a  colour  due  to  its  having  lost  most  of 
its  oxygen,  which  has  been  replaced  by  carbonic  acid ; 
and  the  pulmonary  artery  (5  Fig.  7,  p.  16)  arises  from 
the  right  ventricle  and  carries  this  venous  blood  to  the 
lungs,  where  it  loses  its  carbonic  acid  and  becomes  oxy- 
genated afresh ;  from  the  lungs  it  is  carried  to  the  left 
auricle  by  the  pulmonary  veins,  which  are  the  only  veins 
in  the  body  that  carry  arterial,  or  bright-red  blood,  and 


24 


THE    HEART   AND    ITS    FUNCTION. 


thence  it  passes  anew  through  the  frame;  a  glance  at 
the  diagram  (Fig.  12)  will  make  this  plain. 

Besides  those  very  necessary  and  important  vascular 
links  which  connect  the  heart  with  the  rest  of  the  body, 
and  thus  enable  it  to  discharge  its  functions,  there  are 


Fig.  12. 


other  links  also  which,  though  physically  of  but  small 
account,  are  yet  of  vast  physiological  importance.  There 
are  the  nervous  cords  and  ganglia  which  regulate  the 
movements  of  the  heart,  and  connect  it  functionally  with 
the  rest  of  the  frame. 


THE    HEART   AND    ITS    FUNCTION.  .      25 

CHAPTER  III. 

THE    FUNCTION    OF    THE    HEART,    AND    HOW    IT    IS 
PERFORMED. 

The  function  of  the  heart,  the  work  which  it  has  got  to 
do,  is  to  keep  the  blood  moving  through  the  vessels  at 
such  a  rate,  and  at  such  a  pressure,  as  will  suffice  for  the 
maintenance  of  all  the  organic  functions  in  their  normal 
state. 

This  it  does  by  alternate  movements  of  expansion  and 
contraction — pulsations,  as  these  acts  are  termed — by 
which  the  blood  is  first  received  into  the  dilated  cavities, 
and  then  forcibly  expelled  from  them  in  the  proper 
directions. 

The  cause  of  these  movements  has  been  an  object  of 
the  deepest  interest  to  medical  philosophers  in  all  ages ; 
even  in  our  own  day  it  is  one  of  the  most  difficult 
problems  in  physiology,  and  one  to  which  any  answer  we 
can  give  can  scarcely  be  called  satisfactory. 

The  heart  of  a  shark  has  been  known  to  beat  for  hours 
upon  the  taffrail  of  a  ship,  and  that  of  a  frog  will  beat  for 
twelve  hours  upon  a  plate. 

Muscular  movement  is  always  originated  by  some 
stimulus,  mechanical,  chemical,  or  vital ;  there  is  no 
difficulty  in  understanding  that  in  the  ordinary  conditions 


2  6  -THE   HEART   AND    ITS    FUNCTION. 

of  vitality  the  blood  is  that  stimulant,  the  presence  of 
which  within  the  cardiac  cavities  stimulates  their  walls  to 
contraction.  But  the  heart,  as  we  have  seen,  continues 
to  beat  when  entirely  empty  of  blood ;  nay,  it  has  even 
been  known  to  beat  under  the  exhausted  receiver  of  an 
air-pump.  Its  movements  must  therefore  be  either  truly 
automatic,  and  consequently  quite  peculiar,  or  they  are 
capable  of  being  excited  by  stimuli  so  feeble  in  their 
character  that  no  other  muscle  would  respond  to  them. 
That  is  about  all  that  we  know^  and,  unsatisfactory  as  it 
is,  we  have  no  better  explanation  to  offer.  It  is  quite  a 
different  matter,  however,  to  calculate  the  amount  of 
work  which  the  heart  has  to  do  ;  this  can  be  very  easily 
done  from  the  datum  of  the  blood  pressure  in  the  aorta 
which  keeps  the  semilunar  valves  closed.  This  blood 
pressure  must  be  overcome  before  the  left  ventricle  can 
throw  its  contents  into  the  artery,  and  by  adding  to  this 
the  similar  work  of  the  right  ventricle  it  has  been  found 
that  during  each  twenty-four  hours  the  healthy  average 
human  heart  does  an  amount  of  work  equivalent  to 
raising  92*425  tons  one  foot  high,  or  of  raising  one  ton 
over  92  feet  high,  for  the  terms  are  convertible.  We  may 
form  some  conception  of  the  enormous  energy  of  the 
human  heart  when  we  reflect  that  a  good  climber  can 
only  ascend  9,000  feet  in  nine  hours,  that  is,  can  only 
raise'his  own  weight  1,000  feet  in  one  hour,  that  is,  of 


THE   HEART   AND   ITS   FUNCTION.  27 

course,  continuously  for  any  length  of  time,  while  the 
work  done  by  the  heart  is  equivalent  to  raising  its  own 
weight  (10  oz.)  13,860  feet  high;  and  we  may  put  this 
even  more  strikingly  by  pointing  out  that  the  most 
powerful  engine  ever  made  by  man,  the  "  Bavaria " 
locomotive  of  the  Vienna  and  Trieste  railway,  can  only 
raise  itself  through  2,700  feet  in  one  hour ;  that  is,  its 
energy  is  less  than  one-fifth  of  that  of  the  human  heart 
(Haughton).  Of  course  the  actual  amount  of  work  done, 
both  by  engine  and  climber,  is  much  greater  than  that 
done  by  the  heart ;  but  relative  to  weight,  the  energy  of 
the  heart  far  exceeds  that  of  the  other  two. 

Of  itself  this  energy  is  quite  sufficient  to  carry  on  the 
circulation,  as  we  can  see  in  certain  cases  of  disease, 
where  not  only  are  the  finger-nails  seen  to  flush  and  pale 
alternately  with  each  beat  of  the  heart,  but  even  the  veins 
of  the  arm  may  be  seen  to  pulsate  centripetally,  the 
blood-wave  flowing  onward  toward  the  heart. 

But,  so  rapid  a  passage,  were  it  constant,  would  largely 
defeat  the  object  of  the  circulation.  We  have  seen  that 
this  is  to  maintain  throughout  the  body  a  condition  fit  for 
the  display  of  vital  phenomena,  by  means  of  the  nutritive 
material  and  chemical  agencies  supplied  by  the  blood. 
That  the  frame  may  be  benefited  by  these  life-giving 
properties,  the  blood  must  not  merely  pass  rapidly  through 
the  vessels,  but  must  slowly  permeate  all  the  tissues ;  the 


28  THE   HEART   AND    ITS    FUNCTION. 

mere  circulation  through  the  blood-vessels,  so  obvious  to 
all  our  senses,  must  be  supplemented  by  a  less  obvious 
permeation  of  the  tissues  by  the  nutritive  fluid,  analogous 
to  the  cellular  circulation  of  the  lower  classes  of  animals. 
While,  to  secure  permanent  uniformity  of  action,  the 
blood  supply  must  be  continuous  and  not  intermittent,  and 
must  be  kept  flowing  onward  at  as  uniform  a  pressure 
as  possible.  In  the  healthy  state,  this  constancy  of  the 
rate  and  pressure  of  the  blood-stream  is  secured  by  the 
elasticity  of  the  arteries,  which  converts  the  intermittent 
cardiac  blood- wave,  recognised  in  the  arteries  as  the 
pulse,  into  that  equable  and  continuous  stream  which 
alone  passes  through  the  capillaries,  or  smallest  vessels  in 
the  body,  lying  between  the  arteries  and  veins,  the  name 
being  derived  from  capillus,  a  hair ;  for  in  health  the  pro- 
pulsive action  of  the  heart  is  indistinguishable  beyond  the 
arterioles,  or  smallest  arteries.  It  is,  however,  none  the 
less  real,  though  unperceived.  Fortunately  for  us  it  is 
not  the  sole  agent  concerned  in  maintaining  the  circula- 
tion of  the  blood,  otherwise  we  would  be  in  a  much 
sorrier  plight  than  we  are,  when  our  hearts  get  enfeebled 
or  diseased.  Were  the  arteries  rigid  tubes,  like  leaden 
water-pipes,  exactly  the  same  amount  would  flow  out  at 
the  one  end  as  was  forced  in  at  the  other,  and  with  the 
same  intermittent  action;  the  pressure  inside  the  tubes 
might  indeed  vary,  but  would  only  show  itself  by  the 


THE   HEART   AND    ITS    FUNCTION.  29 

force  with  which  the  fluid  was  ejected,  and  the  occurrence 
of  many  of  those  vital  phenomena  with  which  we  are 
all  familiar  would  be  prevented.  We  would  either  be 
wholly  incapable  of  blushing  or  we  would  be  always  in  a 
flame,  our  eyes  would  either  always  be  dry  or  our  tears 
for  ever  flowing.  From  this  impassive  condition  we  have 
been  saved  by  the  stop-cock  action  of  the  smallest 
arteries,  which  is  the  real  source  of  the  conversion  of  the 
intermittent  action  of  the  heart  into  a  continuous  flow. 
The  elasticity  of  the  arteries  acts  like  the  second  ball  in 
a  hand-ball  bellows,  which  renders  continuous  the  inter- 
mittent action  of  our  hand  upon  the  terminal  ball ;  but  we 
all  know  how  difficult  it  is  to  bring  this  action  into  play 
unless  we  first  compress  the  tube  leading  off"  from  the 
second  ball ;  so,  too,  the  elasticity  of  the  arteries  may  be 
entirely  nullified  by  paralysed  or  relaxed  arterioles. 

The  supplementary  or  subsidiary  forces  which  aid  in 
maintaining  the  circulation  of  the  blood  may  be  divided 
into  extrinsic  and  i?itri?tsic.  Under  the  extrinsic  forces  are 
comprised  all  those  mechanical  and  chemical  forces  which 
suffice  for  the  maintenance  of  the  circulation  in  plants 
and  in  the  lowest  forms  of  animal  life,  such  as  diffusioji 
or  osmosis  and  capillarity,  and  to  these  we  may  also  add 
vttennittent  muscular  action  and  thoracic  aspiration,  the 
latter  being  a  measurable  force  of  very  considerable  im- 
portance.    The  intrinsic  forces  are  of  two  kinds ;  first, 


30  THE    HEART   AND    ITS    FUNCTION. 

rhyfJwiical  vasadar  movement^  which  is  most,  markedly 
automatic  in  the  veins,  though  it  is  more  easily  seen  in 
the  arteries,  where  it  is  apt  to  be  regarded  as  solely  due 
to. the  propulsion  of  the  blood-wave  through  them  by  the 
heart ;  and  second,  cardiac  aspiration^  some  degree  of 
which  necessarily  results  from  the  untwisting  of  the 
cardiac  muscle  itself  during  its  diastolic  relaxation.  It 
seems  more  philosophic  to  regard  these  intrinsic  forces 
as  entirely  one  in  character,  and  perfectly  analogous  to 
the  rhythmical  pulsations  of  the  dorsal  vessel  of  insects, 
the  pulsatory  wave  passing  round  the  vascular  system 
with  the  blood-wave,  its  two  phases  of  diastole  and  systole 
— aspiration  and  propulsion — being  everywhere  distin- 
■  guishable,  though  more  markedly  so  in  the  heart,  which 
is  a  diverticulum  specially  developed  for  certain  specific 
purposes. 

By-and-by  we  shall  be  more  able  to  recognise  the 
importance  of  knowing  the  great  amount  of  work  which 
the  heart  has  to  do,  as  also  the  fact  that  it  is  only  one  of 
a  group  of  organs  which  make  up  what  we  call  our  body, 
all  equally  dependent  on  one  another.  The  stomach 
cannot  digest,  unless  the  heart  is  able  to  keep  the  blood 
pressure  up  to  such  a  pitch  that  the  gastric  juice  is 
secreted  normally  both  as  to  quantity  and  quality ;  but 
neither  can  the  heart  beat  with  sufficient  force  unless  it 
is  supplied  with  blood  (digested  food)  fit  to  maintain  its 


THE   HEART   AND    ITS    FUNCTION.  3 1 

power.  There  are  but  two  organs  out  of  this  interdepen- 
dent group  of  many,  yet  the  most  ignorant  can  readily  re- 
cognise— even  in  this  limited  field — the  difficulty  as  well  as 
the  importance  of  knowing  where  to  begin  in  attempting 
to  restore  the  balance  of  life.  This  is  what  the  physician 
has  to  do,  not  in  regard  to  two  organs  merely,  but  in 
regard  to  all.  And  the  skill  of  one  physician  over 
another  consists  first  of  all  in  his  quickness  to  perceive 
which  organ  he  can  most  readily  and  most  beneficially 
influence,  to  the  ultimate  benefit  of  its  neighbours  ;  and 
next  in  the  extent  of  his  armoury — the  number  of 
weapons,  be  they  drugs  or  diets,  which  he  has  at  his 
command,  and  the  dexterity  with  which  he  can  employ 
them. 

In  attempting  to  obtain  a  general  idea  of  the  circula- 
tion, and  of  the  influence  of  the  heart  upon  it,  it  is  im- 
portant to  remember  that  no  part  of  the  cavity  lying 
inside  of  the  walls  of  the  heart  and  blood-vessels  is  ever 
empty.  We  talk  of  the  veins  being  empty  when  they 
are  not  so  full  of  blood  as  usual ;  and  we  speak  of  the 
auricles  and  ventricles  of  the  heart  being  empty  when, 
by  their  contraction,  the  blood  has  been  forced  out  of 
them.  But,  though  the  veins  may  collapse  more  or 
less,  and  the  cardiac  cavities  may  contract  more  or  less 
perfectly,  there  is  never  within  the  heart  or  vessels  any 
vaciiity  or  empty  space.  The  walls  always  closely  follow 
3 


32  THE   HEART   AND    ITS    FUNCTION. 

the  blood  when  they  contract,  and  when  they  dilate  the 
blood  closely  follows  them,  and  dilatation  ceases  at  once 
whenever  the  blood  ceases  to  follow.  One  important 
result  of  this  is  that  there  can  be  no  muscular  movement 
which  does  not  favour  the  circulation  in  a  twofold 
manner ;  first,  by  compressing  the  veins  during  muscular 
contraction,  and  so  forcing  the  blood  onward  through 
the  nearest  valve  on  the  cardiac  side,  closure  of  the  valve 
on  its  distal  side  preventing  its  going  backwards ;  and 
second,  by  some  degree  of  aspiration  which  must  take 
place  during  muscular  relaxation.  In  like  manner  the 
diastolic  relaxation  of  the  cardiac  cavities,  especially  the 
untwisting  of  the  ventricles,  must  exert  some  degree  of 
aspiratory  or  sucking  force,  and  so  aid  in  promoting  the 
onward  flow  of  the  blood. 

We  must  also  remember  that  though  the  blood  passes 
first  through  the  right  heart,  then  through  the  lungs,  and 
lastly  through  the  left  heart,  yet  the  two  hearts  are  so 
combined  that  both  auricles  and  ventricles  dilate  and 
contract  simultaneously,  presenting  precisely  similar  phe- 
nomena. The  two  hearts,  or  rather  the  two  halves  of 
that  complex  organ  which  we  call  the  heart,  work  together 
— in  health — in  all  respects  correspondingly  and  synchro- 
nously. 

What  we  call  one  beat  or  pulsation  of  our  heart  is  thus 
made  up  of  a  double  series  of  events — that  is  to  say,  each 


THE   HEART  AND   ITS   FUNCTION.  33 

time  that  the  heart  strikes  the  wall  of  the  chest,  or  beats, 
as  we  say,  it  indicates  the  completion  not  of  one  act,  but 
of  a  double  series  of  acts,  each  of  which  occupies  an 
appreciable  interval  of  time,  some  of  them  being  revealed 
by  phenomena  which  are  recognisable  by  other  senses 
than  that  of  touch,  being  also  accompanied  by  sound. 

If  we  divide  the  period  of  one  pulsation  of  our  heart 
into  five  equal  parts,  then  one  of  those  parts  represents 
the  time  occupied  by  the  contraction  of  the  auricles ; 
two  of  these  parts — two-fifths  of  one  heart-beat — are 
taken  up  by  the  systole  of  the  ventricles ;  the  remaining 
period — also  two-fifths — represents  the  diastolic  pause 
common  to  both  auricles  and  ventricles.  The  auricles, 
however,  rest  also  during  the  two-fifths  occupied  by  the 
ventricular  systole,  so  that  the  auricles  rest  during  four- 
fifths  of  each  heart-beat,  and  work  only  during  one-fifth 
of  the  time  between  one  heart-beat  and  another ;  while 
the  ventricles,  in  their  turn,  are  in  diastole  during  the 
one-fifth  occupied  by  the  s,ystole  of  the  auricles,  so  that 
they  jest  during  three-fifths  and  work  only  during  two-fifths 
of  one  entire  pulsation  of  the  heart.  This  will,  however, 
be  more  readily  understood  by  a  reference  to  the  accom- 
panying diagram  (Fig.  13,  from  McKendrick's  "Outlines 
of  Physiology"),  in  which  the  curve  above  the  horizontal 
line  represents  the  systole  of  both  auricles  and  ventricles 
respectively,  while  the  curve  below  the  line  represents 


34 


THE    HEART   AND    ITS    FUNCTION. 


AvcK. 


n/zt. 


the  diastole,  the  X  indicating  the  apex  beat.     The  apex 
beat  is  accompanied  by  a  prolonged  sound,  called  the 

first  sound  of  the  heart,  and 
caused  by  the  closure  of  the 
auriculo-ventricular  valves  al- 
ready referred  to  (p.  1 9).  The 
commencement  of  the  dias- 
tole is  also  signalised  by  a 
short  sharp  sound,  called  the 
second  sound,  and  due  to  the 
snapping  together  of  the  semi- 
lunar valves  (p.  19).  These  sounds  are  readily  heard 
on  listening  over  the  heart,  either  by  simply  apply- 
ing the  ear,  or  through  a  stethoscope,  which,  by  more 
accurately  localising  them,  enables  us  more  certainly  to 
separate  the  one  sound  from  the  other.  Alterations  of 
these  sounds  of  various  kinds  are  among  the  chief  means 
by  which  the  physician  recognises  lesions  of  the  valves  of 
the  heart,  which  originate  in  many  ways,  and  by  impairing 
its  mechanism  tend  to  shorten  life.  Notwithstanding  the 
popular  idea,  death  from  disease  of  the  heart  is  l)y  no 
means  usually  sudden,  much  more  commonly  the  reverse ; 
and  perhaps  it  is  even  not  too  strong  a  statement  to 
make  that  it  is  never  really  sudden,  in  the  sense  of 
unforeseen  or  without  warning,  and  that  there  are  com- 
paratively few  victims  who  have  not  suffered  from  their 


THE   HEART  AND    ITS   FUNCTION.  35 

disease  for  many  years,  and  some  for  so  many  as  from 
twenty  to  thirty  years  before  its  end.  And  indeed  it  is 
perhaps  even  a  more  important  matter  to  remember  that, 
by  whatever  disease  originated,  death  always  occurs  from 
failure  of  the  heart.  The  great  function  of  the  heart  is  to 
maintain  the  blood  pressure  within  the  arteries  at  such  a 
pitch  that  the  circulation  may  be  duly  carried  on  ;  for  in 
order  that  there  may  be  a  circulation  of  the  blood  at  all, 
it  is  absolutely  necessary  that  one  part  of  it — the  arterial 
section  which  begins  the  round — should  be  at  a  higher 
pressure  than  the  venous  section,  which  terminates  it. 
The  tendency,  however,  of  all  the  extrinsic  forces  con- 
cerned in  the  circulation,  is  to  equalise  the  blood  pressure 
throughout  the  vascular  system,  and  so  to  bring  the  circu- 
lation to  a  standstill ;  and  this  is  the  way  in  which  death 
at  last  occurs,  whether  it  occur  suddenly  from  mortal 
faintness,  the  result  of  bleeding,  or  more  slowly  from 
disease,  the  cause  is  still  the  same,  cessation  of  the  circu- 
lation brought  about  by  equalisation  of  the  blood  pressure 
throughout  the  whole  of  the  vascular  system,  or,  as  it 
may  be  otherwise  put,  from  decline  of  the  arterial  (aortic) 
blood  pressure.  Having  already  learned  the  need  there  is 
for  a  due  supply  of  nutritive  fluid  or  blood  in  order  to  the 
manifestation  of  life,  we  can  have  no  difficulty  in  under- 
standing how  its  manifestations  become  feebler  and  feebler, 
and  ultimately  cease  as  the  circulation  gradually  fails. 


36  THE   HEART   AND    ITS    FUNCTION. 


CHAPTER  IV. 

THE    RELATIONS    OF    THE    HEART   TO   THE    GENERAL 
SYSTEM. 

The  heart  is  united  to  every  part  of  our  frame  in  the 
close  bonds  of  a  sympathetic  union  by  means  of  the 
nervous  cords  already  referred  to  (p.  24).  It  is  some- 
what difficult  to  understand  the  manner  in  which  this 
union  is  brought  about,  but  its  practical  results  are 
evident  to  every  one,  and  are  sometimes  very  alarming 
in  their  character.  The  accompanying  diagram  (Fig.  14, 
after  Rutherford)  gives^  a  rough  general  idea  of  the  ana- 
tomical elements  concerned  in  the  nervous  control  of 
the  circulation.  Certain  ganglia  are  seen  lying  within 
the  substance  of  the  heart,  a,  and  these  are  supposed  to 
supply  the  automatic  motor  force  which  causes  its  move- 
ments. The  action  of  these  ganglia  is  controlled,  first 
of  all  by  a  nervous  influence  coming  from  the  sympa- 
thetic system  through  the  ganglion  D  and  along  the  nerve 
H,  which  is  supposed  to  excite  them  to  a  more  rapid 
and  continuous  exercise  of  their  function.  This  nerve 
is  called  the  accelerator  of  the  heart;  it  is  supposed  to 
quicken  the  beat  of  the  heart  and  to  increase  its  force. 
Secondly,  by  an  influence  coming  to  the  heart  through  g, 
a  branch  of  the  ner.ve  i,  called  the  Vagus^  or  wanderer, 


THE    HEART   AND    ITS    FUNCTION. 


37 


because  it  is  distributed  to  many  organs — breast,  lungs, 
stomach,  and  bowels.  The  influence  derived  from  this 
source  inhibits  the  action  of  the  cardiac  ganglia,  slows 
the  heart's  action,  and  if  acting  powerfully  it  arrests  the 


Fig.  14. 


A,  the  heart,  with  its  ganglia,  connected  by  two  nervous  cords,  F  and  G, 
to  the  vagus  nerve,  and  by  one,  H,  with  the  cervical  sympathetic 
ganglion,  D  ;  c  is  the  spinal  cord,  and  m  the  medulla  oblongata  or  upper 
part  of  the  cord  which  connects  it  with  the  brain — the  arrows  show  the 
supposed  course  of  the  nervous  force.    (Rutherford.) 

heart  in  a  state  of  diastole  or  complete  relaxation. 
Lastly,  for  its  own  protection,  it  seems  reasonable  that 
the  heart  itself  should  have  some  control  over  the  circu- 


38  THE   HEART   AND    ITS    FUNCTION. 

lation  through  the  blood-vessels,  and  this  it  is  supposed 
to  exercise  through  the  nerve  f,  which  seems  to  be  only 
another  branch  of  the  vagus,  but  is  regarded  as  really  an 
independent  nerve  passing  upwards  in  the  same  bundle 
with  the  vagus  fibres.  Through  this  nerve  the  heart  is 
able  to  influence  those  centres  in  the  medulla  oblongata 
which  regulate  the  movements  of  the  arterioles,  inhibit- 
ing or  restraining  their  action,  and  in  this  way  producing 
a  paralysis  or  dilatation  of  the  arterioles.  The  blood  is 
thus  permitted  to  pass  more  freely  into  the  veins,  the 
blood  pressure  within  the  arteries  is  lowered,  and  the 
heart,  oppressed  by  an  excess  of  work,  is  immediately 
relieved.  A  similar  inhibitory  influence  is  also  propa- 
gated from  organ  to  organ,  regulating  the  local  circula- 
tion, and  consequently  the  secretions  of  the  various 
glands.  This  system  of  checks  and  counterchecks,  ex- 
ercised on  the  circulation  by  antagonising  influences 
propagated  through  the  nervous  system,  permits  of  the 
temporary  throwing  out  of  gear,  as  it  were,  of  any  organ, 
so  that  secretion  does  not  go  on  continuously  but  only 
as  required.  There  is  thus  a  great  saving  in  the  expendi- 
ture of  energy,  besides  a  great  increase  of  comfort  to 
ourselves.  How  miserable  would  our  existence  be,  were 
our  saUva  always  to  flow  as  profusely  as  it  does  when  the 
secreting  glands  are  appropriately  called  upon;  and 
though  the  expression  "  could  our  tears  for  ever  flow  " 


THE   HEART  AND    ITS    FUNCTION.  39 

may  be  highly  expressive  as  a  poetical  fiction,  the 
reality  would  be  extremely  inconvenient  as  a  physio- 
logical fact. 

The  result  of  this  nervous  control  of  the  circulation  is 
not  only  advantageous  from,  a  utilitarian,  but  quite  as 
much  so  from  an  aesthetic  point  of  view.  It  converts 
what  would  othenvise  have  been  the  passionless  mono- 
tony of  our  existence,  into  the  scene  of  an  ever-varying 
emotional  display,  which  adds  an  otherwise  unattainable 
zest  to  life,  has  proved  a  fruitful  source  of  inspira- 
tion to  poets  and  painters  in  all  ages,  and  has  even, 
strange  to  say,  enhanced  the  monetary  value  of  those 
exhibiting  it ;  for  it  is  said  that  the  Sultans  of  old  were 
wont  to  give  a  higher  price  for  those  Circassian  females 
whose  faces  could  light  up  with  "  love's  own  changeful 
hues,"  than  for  their  less  susceptible  sisterhood. 

Any  emotion,  be  it  pleasing  or  painful,  Tove  or  fear,  is 
only  consciously  realised  through  the  medium  of  the 
cerebrum  or  large  brain,  and  it  is  through  the  nervous 
connections  subsisting  between  the  cerebrum  and  the 
centres  controlling  the  circulation  that  the  distinctive 
phenomena  of  each  emotion  are  produced.  Not  by  any 
vague  sympathy  of  the  parts,  as  was  formerly  supposed, 
but  by  a  distinct  controlling  influence  conveyed  to  the 
nerve  centres  that  regulate  the  circulation,  which  inhibits 
or  stimulates  them  as  the  case  may  be,  and  which  may 


40  THE   HEART  AND    ITS   FUNCTION. 

be  successfully  imitated  experimentally.  The  coexistence 
of  consciousness  with  emotion  indescribably  enhances  the 
phenomenal  display  by  combining  with  it  the  appropriate 
expression  as  revealed  in  the  play  of  the  features,  the 
gestures  of  the  limbs,  and  the  light  in  the  eyes.  The 
intensity  of  the  emotion  is  further  indicated  by  certain 
subsidiary  phenomena,  which  imply  the  persistence  of  an 
increased  or  diminished  blood  supply  to  the  surface  of  the 
body,  or  to  certain  glands  where  secretions  are  corre- 
spondingly affected.  Evanescent  feelings  of  short  dura- 
tion only  give  rise  to  those 

"  Playful  blushes  that  seem  nought 
But  luminous  escapes  of  thought," 

unaccompanied  by  any  physical  discomfort,  except  a 
slightly  quickened  action  of  the  heart.  But  tears  of 
vexation  and  a  flush  of  heat  are  prone  to  accompany  the 
blush  of  shame ;  while  the  bashful  man,  when  he  blushes, 
very  soon  gets  not  only  uncomfortably  hot  but  also  moist 
with  perspiration.  It  is  not  the  face  only  that  blushes  in 
these  circumstances,  but  the  whole  surface  of  the  body  is 
flushed  and  feels  hot,  while  the  heart  beats  with  a  violence 
proportionate  to  the  intensity  of  the  emotion.  Blushing 
is  often  attributed  to  the  exquisite  sensibility  of  youth, 
which,  according  to  popular  belief*,  wears  away  with 
advancing  years.     This  is  the  idea  that  strikes  the  gene- 


THE   HEART   AND    ITS    FUNCTION.  4 1 

rality  of  observers,  and  with  this  they  are  satisfied 
.  (Burgess).  But  the  aged  cheek  can  blush  as  deeply  as 
the  most  youthful,  upon  adequate  provocation.  The 
blush  of  age  is  only  rare,  because  long  experience  of  the 
world  gradually  teaches  us  to  estimate  our  surroundings, 
and  the  events  that  befall  us,  at  more  nearly  their  true 
value,  and  thus  we  cease  to  be  so  strongly  moved  by 
them.  No  mere  physical  cause  can  produce  a  blush ; 
but  when  once  a  sufficient  emotional  cause  has  arisen,  no 
effort  of  the  will  can  arrest  the  resulting  blush.  When 
blushing,  therefore,  has  become  a  painful  habit,  it  is 
hopeless  to  attempt  to  check  it  by  any  opposition  of  our 
will ;  this  only  leads  to  signal  failure,  which  is  the  more 
disheartening,  the  more  powerfully  we  have  striven  to 
attain  our  end.  The  only  hope  of  overcoming  this  objec- 
tionable habit  lies  in  cultivating  feelings  directly  opposed 
to  those  which  give  rise  to  it,  so  that  the  influence  of  the 
baneful  emotion  is  opposed  by  a  pre-existing  antidote. 
As  most  of  these  cases  arise  from  an  overweening  sensi- 
tiveness to  the  opinion  of  the  world,  it  is  desirable  to 
cultivate  such  a  moderately-good  opinion  of  our  own 
worth,  wealth,  or  appearance  as  shall  suffice  to  counteract 
this ;  and  it  is  alleged  that  a  free  use  of  the  Kilbarchan 
weaver's  prayer,  "  O  Lord  !  gie  me  a  gude  conceit  o' 
mysel',"  has  occasionally  been  followed  by  the  happiest 
results. 


42  THE   HEART   AND    ITS    FUNCTION. 

The  sensation  of  fear  is  followed  by  very  different  con- 
sequences from  those  of  the  emotions  just  referred  to. 
Juliet — whom  no  one  could  accuse  of  being  cold-blooded 
— when  about  to  take  her  sleeping-draught,  and  while 
youthful  love  and  hope  still  lent  their  aid  to  cheer  her, 
yet  acknowledges  that  owing  to  her  dread  of  what  might 

happen — 

**A  faint  cold  fear  thrills  through  my  veins 
That  almost  freezes  up  the  heat  of  life  j" 

while   Macbeth,  whose  antecedents  at  least,  if  not  his 

character  also,  exposed  him  to   the  full  force  of  such  an 

emotion,  exclaims   to   his   wife    when    Banquo's    ghost 

appears — 

"You  make  me  strange, 
Even  to  the  disposition  that  I  owe, 
When  now  I  think  you  can  behold  such  sights, 
And  keep  the  natural  ruby  of  your  cheeks, 
When  mine  are  blanched  with  fear  j" 

and  in  another  place  he  even  more  emphatically  expresses 
the  results  of  this  emotion,  saying — 

*'  This  horrid  image  doth  unfix  my  hair 
And  make  my  seated  heart  knock  at  my  ribs 
Against  the  law  of  nature." 

Using  words  which  recall  those  of  an  earlier  poet,  Virgil, 
who  makes  ^Eneas  exclaim  on  meeting  the  gliost  of  his 


THE   HEART  AND   ITS   FUNCTION.  43 

beloved  Creusa  wandering  through  the  blood-stained 
streets  of  Troy — 

"  Obstupui,  steteruntque  comae,  et  vox  faucibus  haesit " — 

"  I  was  amazed,  my  hair  stood  on  end,  and  my  voice  stuck 
in  my  throat."  'Tis  but  a  schoolboy  quotation,  but  it 
supplements  the  others,  and  shows  how  fear  in  its  results 
is  exactly  the  counterpart  of  the  warmer  if  not  more  ex- 
citing emotions.  The  surface  is  pale  and  cold,  and  the 
secretions  dried  up,  making  not  only  speech  but  even  de- 
glutition imperfect.  We  all  remember  the  Indian  method 
of  detecting  a  thief,  the  pinch  of  rice  given  to  each  sus- 
pected person  to  chew  in  solemn  conclave,  the  result  being 
that  he  whose  conscience  has  made  him  coward  is  at  last 
forced  to  spit  out  his  moiety,  broken  indeed  by  his  teeth, 
but  dry  as  he  at  first  received  it,  the  fear  of  detection 
inevitably  bringing  about  the  fact. 

In  these  two  classes  of  emotion,  the  influence  conveyed 
to  the  centres  controlling  the  circulation  acts  differently ; 
in  the  one  case  the  action  of  these  is  inhibited  or  para- 
lysed, and  in  the  other  they  are  stimulated  to  more  power- 
ful action.  We  cannot  by  any  physical  agency  produce 
these  results  and  prove  this  fact ;  we  cannot  even  physi- 
cally reach  these  controlling  centres  without  destroying 
the  perfection  of  the  mechanism  ;  but  we  can  do  almost 
as  well,  we  can  attack  the   nerves  passing  from  these 


44  THE    HEART   AND    ITS    FUNCTION. 

centres  to  the  peripheral  vessels  of  some  transparent  part, 
such  as  the  ear  of  a  rabbit,  and  by  cutting  them  across  we 
paralyse  the  muscular  coat  of  the  small  arteries  to  which 
they  are  distributed,  the  vessels  at  once  dilate  under  the 
pressure  of  the  advancing  blood-wave  and  the  ear  becomes 
red  and 'hot;  it  is  in  a  state  of  permanent  blush.  Now 
suppose  we  irritate  or  stimulate  the  end  of  the  nerve 
which  remains  connected  with  the  blood-vessels,  which  has 
all  the  effect  of  a  stimulation  of  the  nerve  centres,  the 
immediate  result  is  that  the  muscular  coat  of  these  small 
arteries  is  thrown  into  a  state  of  violent  contraction,  just 
as  the  muscle  of  an  arm  is  made  to  contract  by  passing  an 
electric  current  through  it,  the  blood-wave  is  either  com- 
pletely stopped  or  so  greatly  diminished  that  the  ear 
becomes  pale  and  cold.  From  these  experiments  we  are 
warranted  in  concluding  that  those  emotions  which  pro- 
duce blushing,  inhibit  or  paralyse  the  nerve  centres  as 
effectually  as  if  they  severed  them  from  the  parts  which 
they  normally  influence ;  while  those  which  produce 
pallor  stimulate  these  centres  to  increased  action.  The 
excited  action  of  the  heart,  which  so  constantly  accom- 
panies powerful  emotion  of  any  kind,  is  partly  due  to 
alterations  of  the  blood  pressure  within  the  arteries, 
a  matter  that  naturally  depends  upon  the  greater  or 
less  readiness  with  which  the  blood  passes  out  of  the 
arteries  into  the  veins,  according  as  the  arterioles   are 


THE   HEART   AND   ITS   FUNCTION.  45 

dilated  or  contracted.  But  it  is  perhaps  even  more 
largely  due  to  the  direct  influence  of  the  emotion  upon 
the  heart  itself,  which,  if  it  comes  through  the  sympa- 
thetic, accelerates  its  action  and  produces  palpitation ; 
while,  if  it  comes  through  the  vagus,  it  arrests  the  heart's 
action,  either  temporarily  producing  an  intermission  or 
momentary  stoppage  of  the  heart,  which  may  occur  once, 
may  recur  several  times,  or  may  even  give  a  new  rhythm 
to  the  heart's  action  which  may  persist  for  days,  months, 
or  years,  or  which  may  prove  suddenly  fatal.  This  inhi- 
bition of  the  heart  is  readily  observed  in  the  frog,  whose 
heart  will  beat  for  an  indefinite  period  after  all  sensibility 
has  been  obliterated  by  destruction  of  the  brain.  The 
body  of  such  a  frog  may  be  laid  open  without  causing 
any  pain  or  disturbance,  and  the  heart  will  be  found 
beating  with  perfect  regularity.  If  we  attach  to  such  a 
heart  a  long  index  like  a  metronome,  this  will  be  moved 
backwards  and  forwards  with  every  movement  of  the 
heart;  and  if  we  send  an  electric  shock  through  the 
pneumo-gastric  nerve  of  a  frog  so  prepared,  in  one  instant 
the  index  stops,  and  the  heart  lies  motionless  in  diastole 
with  all  its  cavities  dilated;  by-and-by  its  contractions 
recommence,  and  the  experiment  may  be  many  times 
repeated  (Huxley).  In  this  simple  way  we  gain  the  clue 
to  intermittent  action  of  the  heart,  and  a  knowledge  of 
the  mechanism  of  its  production,  invaluable  as  ■  an  aid  to 


46  THE   HEART   AND    ITS    FUNCTION. 

prevention,  and  forming  a  very  safe  guide  to  appropriate 
treatment,  is  surely  cheaply  bought  at  the  expense  of  a 
few  frogs. 

Excessive  emotion  has  not  infrequently  proved  suddenly 
fatal  by  inhibition  or  arrest  of  the  heart's  action,  probably 
never  in  those  whose  hearts  are  perfectly  healthy,  but  it 
has  occurred  sufficiently  often  in  those  who  were  not 
known  to  suffer  from  actual  disease  of  the  heart,  though 
from  their  age  or  for  other  reasons  that  organ  must  pro- 
bably have  been  to  some  extent  degenerated.  Though 
all  excessive  emotion  is  liable  to  this  fatal  termination, 
one  would  scarcely  expect  to  find  that  unexpected  joy  is 
more  dangerous  to  life  than  sudden  grief;  yet  recorded 
instances  of  fatal  joy  are — according  to  Zimmermann,  who 
has  published  a  large  collection  of  such  cases — more 
frequent  than  those  of  death  from  grief.  Sophocles,  de- 
sirous of  proving  the  full  possession  of  his  intellectual 
powers,  which  had  been  called  in  question,  composed  a 
tragedy  when  over  ninety  years  of  age,  was  crowned  as 
the  first  tragic  poet  of  the  age,  and  died  suddenly  of  joy. 
Manius  Juventius  Thalna,  when  decreed  a  triumph  for 
having  conquered  Corsica,  dropped  dead  from  joy  on 
receiving  the  intelligence.  The  famous  Fouquet  died 
suddenly  on  being  told  that  Louis  XIV.  had  restored  him 
to  liberty.  The  niece  of  Leibnitz  died  of  joy  on  finding 
a  box  containing  sixty  thousand  ducats  below  the  phi- 


THE    HEART    AND    ITS    FUNCTION.  47 

losopher's  bed;  and  there  are  a  host  of  similar  cases 
recorded,  both  in  ancient  and  in  more  modern  times, 
testifying  to  the  fatal  influence  of  sudden  joy.  Nor 
are  cases  wanting  to  prove  that  other  and  more  depress- 
ing passions  have  an  equally  fatal  result  by  inhibition  of 
the  heart.  By  a  poetical  license  Shakespeare,  speaking 
in  the  person  of  Marc  Antony,  represents  the  death  of 
Julius  Caesar  as  occurring  in  this  manner,  and  not  from 
the  daggers  of  the  conspirators — 

"  This  was  the  unkindest  cut  of  all ; 

For  when  the  noble  Caesar  saw  him  stab, 

Ingratitude,  more  strong  than  traitors'  arms, . 

Quite  vanquished  him  ;  then  burst  his  mighty  heart, 

And,  in  his  mantle  muffling  up  his  face, 

Even  at  the  base  of  Pompey's  statue, 

Which  all  the  while  ran  blood,  great  Caesar  fell." 

Philip  II.  seems  to  have  been  a  terrible  monarch,  for 
it  is  related  of  him  that  he  killed  two  Ministers  of  State 
with  the  breath  of  his  mouth  :  one  he  severely  rebuked 
for  answering  him  with  some  hesitation ;  the  poor  man 
dropped  dead.  To  another,  the  Cardinal  Espinosa,  he 
said,  "  Cardinal,  know  that  I  am  master !"  the  Cardinal 
was  so  terrified  that  he  died  a  few  days  afterwards. 
Philip  V.  died  suddenly  on  being  told  that  the  Spaniards 
had  been  defeated  ;  his  heart  was  found  to  be  ruptured. 
Palmer,  a  well-known  comedian,  died  on  the  stage  of  the 
4 


48  THE   HEART   AND   ITS    FUNCTION. 

Liverpool  theatre  on  August  2,  1798,  while  performing 
the  part  of  "  The  Stranger,"  in  the  play  of  that  name. 
He  had  recently  lost  his  wife  and  a  favourite  son,  and 
when,  in  the  course  of  the  play,  one  of  the  dramatis  per  so7ice 
asked  for  his  family,  in  attempting  to  reply  Palmer  became 
inexpressibly  agitated,  and  fell  dead.  Many  similar  cases 
have  been  recorded.  Mallet's  tale  of  Edwin  and  Emma, 
in  which  the  latter  dies  suddenly  of  a  broken  heart  on 
hearing  of  the  death  of  her  lover,  was  founded  on  an 
actual  and  precisely  similar  occurrence  which  happened 
in  1 7 14  at  Bowes,  in  Yorkshire.  The  expression  "  broken 
heart "  is  sometimes  expressive  of  an  actual  fact — a  dis- 
eased and  enfeebled  heart  not  infrequently  rupturing 
under  the  distending  influence  of  inhibitory  dilatation. 
More  often  it  is  used  figuratively,  as  when  Shakespeare 
makes  Malcolm  say  to  Macduff,  horror-struck  at  hearing 
of  the  murder  of  his  wife  and  children, 

*'  Give  sorrow  words  :  the  grief  that  doth  not  speak 
Whisper's  the  o'erfraught  heart  and  bids  it  break  ;" 

and  then  it  means  only  that  intense  feeling  of  oppression 
at  the  chest,  produced  by  emotional  inhibition  of  the 
heart,  identical  with  the  arrest  of  the  heart  in  diastole 
produced  by  irritation  of  the  vagus,  which  may  terminate 
in  rupture  if  the  muscular  fibre  of  the  heart  be  diseased, 
and  which  probably  is  never  fatal  even  from  inhibitory 


THE    HEART   AND    ITS    FUNCTION.  49 

dilatation  alone,  unless  the  heart  has  been  previously 
diseased.  At  all  events,  no  such  case  has  been  recorded 
within  the  last  thirty  years,  since  the  diseases  of  the  heart 
have  been  more  carefully  studied  and  better  under- 
stood. When  the  emotional  excitement  has  not  been 
great  enough  to  cause  death  by  instantaneous  and  per- 
manent arrest  of  the  heart's  action,  its  effects  may  vary 
from  the  more  or  less  thumping  and  somewhat  tumultuous 
action  of  the  heart,  of  which  we  are  all  more  or  less  con- 
scious when  momentarily  alarmed,  to  a  more  persistent 
alteration  of  the  heart's  rhythm,  which  is  then  said  to  be 
intermittent^  because  the  momentary  inhibition  of  the 
heart  causes  a  failure  of  the  pulse  at  the  wrist  which  is 
technically  called  an  interims sioJi.  This  intermittent  action 
of  the  heart  is  sometimes  accompanied  by  an  uneasy 
sensation  within  the  chest,  and  at  others  it  is  wholly  un- 
noted by  the  sufferer.  Anxiety,  grief,  terror,  violent  anger, 
or  excessive  fatigue,  have  all  been  noticed  as  occasional 
causes  of  this  intermittent  action  of  the  heart.  And  it 
has  been  remarked  that  the  ultimate  results  have  varied 
according  to  the  violence  of  the  emotion  on  the  one 
hand,  and  the  sensitiveness  of  the  organism  on  the  other  ; 
so  that  in  some  individuals  the  result  dies  off  with  the 
fading  of  the  emotion  which  produced  it,  an  intermission 
which  has  at  first  occurred  once  every  two  or  three  beats, 


50         THE  HEART  AND  ITS  FUNCTION. 

and  has  been  accompanied  by  great  uneasiness,  gradually 
dying  off  till  it  occurs  only  exceptionally  at  long  intervals, 
and  is  wholly  unnoted  by  the  patient  except  as  an  objec- 
tive phenomenon ;  while  in  others  the  disturbed  rhythm 
of  the  heart  persists  as  a  fact  of  which  the  sufferer  cannot 
for  one  instant  lose  the  consciousness,  and  which  ulti- 
mately wears  him  out  by  the  silent  but  terrible  and  sleep- 
less suffering  it  produces.  When  the  individual  has  been 
fairly  robust  previous  to  his  exposure  to  some  cause  of 
sudden  overwhelming  emotion,  the  most  common  result 
is  a  gradual  and  complete  disappearance  of  the  unnatural 
rhythm,  the  only  remanent  trace  of  inhibitory  derange- 
ment being  shown  by  an  unnatural  proclivity  to  a  return 
to  an  abnormal  rhythm  upon  very  slight  provocation. 

Fatal  inhibition  of  the  heart  may,  however,  arise  from 
other  causes  than  emotion  ;  cold  to  the  surface  or  to  the 
stomach  are  quite  common  sources  of  fatal  cardiac  inhibi- 
tion, while  the  ingestion  of  indigestible  food  is  the  most 
common  cause  of  all.  Not  a  summer  passes  that  some  are 
not  said  to  be  drowned  by  being  seized  with  cramp ;  they 
have  indeed  neither  been  seized  with  cramp,  nor  drowned; 
the  individual  dies  at  the  moment  when,  swimming  easily 
about,  he  suddenly  throws  up  his  arms  and  sinks  to 
the  bottom,  the  pulsation  of  iiis  heart  fatally  arrested 
by  the  inhibitory  influence  of  cold  propagated  from  the 
surface  of  the  body.     Infants  sometimes  die  in  the  same 


THE    HEART   AND    ITS    FUNCTION.  $1 

way  from  the  shock  of  a  cold  bath.  Taken  into  the 
stomach  cold  water  even  more  readily  excites  the  fatal 
inhibitory  influence  of  the  pneumo-gastric  nerve ;  scarcely 
an  autumn  passes  without  there  being  one  or  more  deaths 
in  the  harvest  field  from  this  cause ;  and  it  has  been 
alleged  that  Alexander  the  Great  lost  more  of  his  men 
from  drinking  the  cold  waters  of  the  Oxus  than  from 
all  the  battles  which  he  fought  during  his  Eastern  cam- 
paign. But  of  all  the  causes  of  cardiac  inliibition,  the 
most  common  of  all,  and  fortunately  as  a  rule  the  least 
serious,  is  the  irritation  produced  by  a  little  wind  in  the 
stomach  (flatulence),  or  by  some  undigested  food,  both 
of  these  causes  being  often  associated,  as  the  one  is  a 
most  common  result  of  the  other.  Indigestion,  compre- 
hensively understood  and  from  whatever  source  arising,  is 
thus  the  most  frequent  cause  of  intermission  of  the  heart's 
action.  The  sufferers  indeed  scout  this  idea ;  they  never 
have  a  headache,  are  never  sick,  have  always  a  good 
appetite,  and  can  eat  anything  they  please  with  apparent 
impunity,  so  far  at  least  as  the  stomach  is  concerned. 
True,  their  indigestion  affects  their  heart  and  not  ap- 
parently the  stomach,  but  we  know  that  this  is  not  really 
the  case,  and  that  the  heart  is  only  affected  secondarily. 
And  even  in  those  cases  which  have  to  all  appearance  the 
least  connection  with  the  stomach,  a  careful  attention  to 
it,  with  strict  regulation  of  the  diet  and  other  appro- 


52  THE    HEART   AND    ITS    FUNCTION. 

priate  remedies,  will  often  be  attended  by  the  happiest 
results. 

Sometimes  the  cardiac  inhibition  is  not  powerful  enough 
to  arrest  the  heart's  action  even  temporarily ;  it  merely 
weakens  it :  the  pulse  falters,  beats  feebler  than  usual  for 
a  time  or  two,  the  heart  being  simultaneously  felt  to 
flutter,  its  ventricular  contraction  is  not  arrested  but 
merely  enfeebled,  and  its  action  is  not  intermittent  but 
merely  irregular.  Palpitation^  on  the  other  hand,  is  simply 
an  unusually  rapid  action  of  tlie  heart,  sometimes  purely 
emotional  in  its  character,  and  then  commonly  of  but 
short  duration,  while  at  others  it  arises  from  some  physi- 
cal or  inflammatory  irritation,  and  then  it  is  more  perma- 
nent in  its  character,  and  may  persist  for  many  months. 
These  modes  of  perverted  action  of  the  heart,  though 
troublesome  and  sufficiently  alarming  to  the  sufferer,  are 
rarely  indicative  of  any  real  danger,  though  they  usually 
betoken  an  exceptional  degree  of  irritability  of  the  cardiac 
muscle  as  well  as  of  nervous  mobility,  a  state  of  matters 
which,  if  associated  with  actual  disease,  may  cause  them  to 
be  more  or  less  serious  complications. 

Our  present  organisation  is  such,  that  if  one  organ 
suffers  the  others  suffer  with  it ;  to  the  ignorant,  these 
sufferings  are  often  eccentric,  bizarre^  and  incomprehen- 
sible. Thus,  decayed  teeth  may  pjroduce  blindness  or  a 
neuralgic  shoulder-joint,  a  worm  in  the  bowels  may  give 


THE    HEART   AND    ITS    FUNCTION.  53 

rise  to  a  most  lioublesome  cough,  and  flatulent  dyspepsia 
may  only  reveal  itself  by  the  most  extraordinary  vagaries 
on  the  part  of  the  heart. 

Though  weak  hearts  are  more  liable  to  have  their 
action  perverted  by  ordinary  causes,  yet  if  the  exciting 
cause  be  a  powerful  one,  the  very  strongest  heart  will 
hardly  escape.  This  is  the  penalty  we  pay  for  our 
present  state  of  being ;  it  is  the  result  of  our  having  a 
nervous  system  which  not  only  helps  us  to  all  enjoyment 
but  which  is  also  incidentally  the  cause  of  much  suffering, 
yet  without  which  our  organism  could  not  exist  for  an 
hour. 


CHAPTER  V. 

HOW  TO   MAINTAIN    THE    INTEGRITY   OF    THE   HEART's 
FUNCTION. 

When  we  consider  the  importance  of  the  heart's  function 
to  the  maintenance  of  life,  and  the  vast  amount  of  work 
which  the  heart  performs  in  the  discharge  of  this  function, 
not  for  one  hour,  one  day,  or  one  year,  but  for  seventy 
odd  years  unintermittingly,  we  can  understand  the  im- 
portance of  some  little  care  on  our  part  to  maintain  its 
pristine  vigour  as  long  as  possible,  and  to  ward  off  aU 
injurious  influences  to  the  best  of  our  ability. 


54  'i'HE    HEART   AND    ITS    FUNCTION. 

We  have  learned  that  though  the  heart  could  send  the 
blood  through  the  body  like  a  great  bore-wave,  rushing 
from  left  ventricle  to  right  auricle,  yet  it  does  not  do  so, 
things  being  so  arranged  as  to  make  its  great  function 
merely  the  maintaining  of  such  a  continuous  pressure 
within  the  arterial  system  as  to  secure  the  onward  flow 
of  the  blood,  so  that  when  the  nervous  system — which 
holds  the  keys  of  all  our  wants — opens  the  sluices  in  any 
one  direction,  the  blood  may  flow  in  at  once  with  such 
force  as  will  allow  the  gland  to  functionate  actively,  no 
other  part  of  the  body  suflering.  When  this  is  the  case 
we  possess  all  the  delightful  energy  of  perfect  health ;  we 
can  think  clearly,  walk  without  fatigue,  and  digest  our 
food  without  trouble ;  all  of  course  in  moderation,  because 
our  organs  need  to  be  rested  and  repaired,  and  there  is 
no  other  organ  but  the  heart  which  t^kes  both  its  food 
and  its  rest  by  the  way  as  it  were,  in  short  snatches 
during  its  period  of  action  (vide  p.  33).  When  the  circu- 
lation, however,  is  languid  and  feeble,  everything  is 
reversed,  every  act  of  life  is  more  or  less  imperfectly 
performed,  and  its  performance  is  accompanied  with  more 
or  less  discomfort.  In  this  state  we  are  not  necessarily 
ill,  but  neither  are  we  well,  and  we  are  little  able  to  resist 
the  thousand  ailments  to  which  we  are  continually  ex- 
posed ;  the  germs  of  zymotic  (febrile)  or  parasitic  disease 
find  a  suitable  and  congenial  soil  in  the  slowly  and  im- 


THE   HEART    AND    ITS    FUNCTION.  55 

perfectly  renewed — and  consequently  enfeebled — tissues. 
Nay,  the  very  imperfectly  renewed  tissues  are  themselves 
a  source  of  disease ;  the  impure  blood  may  be  either 
rheumatic  or  gouty,  and  besides  giving  rise  to  many 
symptoms  of  disease  peculiar  to  itself,  it  may  seriously 
modify  every  phase  of  life,  whether  actually  morbid  or 
apparently  healthy.  With  impure  blood  supplied  at  a 
low  pressure  every  gland  must  of  course  secrete  un- 
healthily, both  as  to  quality  and  quantity;  and  at  the 
best  the  unhappy  individual  lives  in  a  vicious  circle,  from 
which  he  can  only  emancipate  himself  by  slow  degrees 
and  by  careful  accumulations  of  trifling  advantages.  In 
this  condition  there  is  defective  energy,  life  is  poisoned 
at  its  springs,  and  the  unhappy  victim  leads  a  more  or 
less  ailing  life,  prone  to  many  diseases,  unable  to  resist 
any  effectively,  and,  unless  his  health  is  improved,  his  life 
is  ultimately  shortened  by  one  or  other  of  these  organic 
ailments  which  necessarily  arise  from  his  state  of  abnormal 
nutrition,  and  in  which  the  heart  plays  no  unimportant 
part. 

It  has  been  already  stated  that  it  is  by  the  more  gradual, 
or  by  the  sudden  lowering,  of  the  arterial  blood  pressure 
that  death  occurs  in  every  form  of  disease.  It  can  be 
readily  understood,  therefore,  that  the  condition  of  the 
great  central  organ  of  the  circulation  is  an  object  of 
anxious   interest  in   all   serious  febrile  or  inflammatory 


56  THE   HEART   AND    ITS    FUNCTION. 

disease,  and  that  the  feehng  of  the  pulse  is  not  a  mere 
form;  while,  though  its  rate  is  not  an  altogether  unim- 
portant matter,  its  force  and  character  are  of  very  much 
greater  consequence,  inasmuch  as  they  are  truer  indications 
of  the  state  of  the  blood  pressure,  and  consequently  of 
the  heart. 

The  blood  pressure  signifies  the  state  of  arterial  ten- 
sion, and  is  made  up  of  three  factors — the  amount  of 
blood  in  the  arteries,  the  strength  of  the  heart's  contrac- 
tion, and  the  state  of  the  arterioles — that  is,  the  greater 
or  less  readiness  with  which  the  blood  escapes  from  the 
arteries  into  the  veins.  If  either  of  these  factors  fail,  the 
blood  pressure  falls,  the  circulation  is  only  maintained 
with  difficulty  and  after  a  precarious  fashion;  whether  it 
can  ever  be  again  restored  to  its  positive  state  of  security 
depends  very  much  upon  the  cause  of  the  change  which 
has  taken  place.  The  change  itself  is  readily  appreciateti 
by  the  educated  finger,  but  the  outline  of  the  blood-wave 
passing  through  the  arteries  is  sufficient  to  make  this 
change  obvious  to  the  most  uneducated  eye.  This  out- 
line we  usually  obtain  from  the  artery  at  the  wrist,  where 
the  pulse  is  commonly  felt,  by  means  of  an  instrument 
termed  the  sphygmograph,  or  pulse  writer ;  and  the  ap- 
pearance of  the  tracing,  from  arteries  in  different  states 
of  tension,  is  sufficient  to  show  to  the  most  ignorant 
that  different  conditions  are  present,  though  considerable 


THE  HEART  AND  ITS  FUNCTION.         57 

explanation  would  doubtless  be  required  to  elucidate  the 
causes  of  these  varying  conditions,  as  well  as  the  manner 
in  which  their  respective  characteristics  are  impressed 
upon  the  blood-wave  and  its  tracing.  When  the  blood 
pressure  is  at  a  minimum  from  failure  of  the  heart,  the 
resulting  blood-wave  is.  only  able  to  trace  a  slightly  undu- 
lating, almost  straight  line.  The  normal  blood-wave  gives 
a  bold  tracing  of  a  somewhat  peculiar  form,  such  as  we 
find  at  a  Fig.  15,  the  upright  stroke  of  which  represents, 
by  its  height  and  mode  of  junction  with  the  descending 
obHque  line,  the  fulness  and  force  of  the  heart's  con- 
traction; while  the  obliquely  descending  line  indicates, 
by  the  number  and  form  of  its  undulations,  various  par- 
ticulars as  to  the  state  and  tension  of  the  arterial  wall. 
Fig.  15  ^  represents  a  tracing  of  the  dicrotic,  or  doubly 
beating  pulse  common  in  many  diseases,  and  capable  of 
being  artificially  produced  by  the  administration  of  those 
drugs  which  paralyse  and  dilate  the  arterioles ;  it  indi- 
cates, therefore,  a  blood  pressure  below  the  normal,  due 
rather  to  too  free  an  escape  of  the  blood  from  the  arteries 
than  to  failure  of  the  heart  power.  And  Fig.  15  ^  is  a 
tracing  from  an  artery  in  quite  the  opposite  condition ; 
one  in  which  the  tension  is  increased  because  the  arteries 
generally  have  lost  their  elasticity,  and  the  blood  cannot 
get  so  freely  away  as  it  ought.  This  is  a  condition  which 
occurs  after  middle  life  more  or  less  in  all,  and  is  the 


58 


THE   HEART   AND    ITS    FUNCTION. 


most  common  cause  of  disease  of  the  heart  in  elderly 
people. 

When  the  blood  pressure  falls,  there  is  a  risk  of  death 

Fig.  15. 


occurring  in  no  long  time  from  gradual  cessation  of  the 
circulation  ;  it  is  important,  therefore,  to  recognise  this 


THE    HEART    AND    ITS    FUNCTION.  59 

condition  early,  in  order  that  appropriate  measures  may- 
be employed  to  remedy  it,  and  by  timely  stimulation  of 
the  heart  we  may  be  enabled  to  rouse  its  energy^  and  thus 
rally  the  patient  from  an  apparently  desperate  condition, 
and  thus  save  a  useful  life.  A  rise  in  the  blood  pressure 
is  rarely  an  indication  of  immediate  danger ;  more  com- 
monly this  is  remote  ;  but  it  is  not  less  our  duty  to  fore- 
stal  possible  evils,  and  by  appropriate  remedies,  and,  in 
those  cases  where  it  depends  upon  loss  of  arterial  elas- 
ticity, by  a  wise  guidance  of  all  our  future  life,  we  must 
endeavour  to  avert  the  failure  of  the  heart's  force.  By  so 
doing  we  shall  very  often  be  able  to  maintain  a  very  con- 
siderable degree  of  comfort,  and  shall  at  all  events  be 
able  to  postpone  the  inevitable  end.  But  all  this  belongs 
to  the  history  of  medicine  proper,  while  here  we  have 
only  to  do  with  the  prophylaxis,  or  art  of  warding  off 
disease  of  the  heart — a  subject  of  sufficient  interest, 
seeing  that,  even  from  the  comparatively  limited  point 
of  view  of  the  Registrar-General,  it  involves  an  annual 
mortality  of  30,000  in  England  and  Wales  alone,  being 
one-sixth  of  the  total  annual  mortality;  while  from  a 
pathological  point  of  view  a  very  much  greater  number 
indeed  owe  their  death  to  lesions  which,  if  not  all 
strictly  cardiac  in  their  origin,  are  yet  truly  diseases 
arising  in  the  circulatory  apparatus,  and  owing  their  fatal 
progress  directly  to  cardiac  failure,  though  reckoned  under 


60  THE    HEART   AND    ITS    FUNCTION. 

many  various  heads;  and  in  this  calculation  all  febrile  or 
inflammatory  diseases  are  excluded. 

The  further  consideration  of  this  part  of  our  subject 
may  be  very  profitably  pursued  under  the  several  heads 
of  childhood,  youth,  middle  age,  and  old  age. 

Even  before  birth  the  heart  may  be  so  irretrievably 
damaged  by  arrest  of  development,  or  alterations  pro- 
duced by  disease,  chiefly  of  an  inflammatory  character,  as 
to  make  independent  life  much  more  truly  one  long  disease 
than  it  is  so  often  represented  to  be — even  at  its  best. 
Between  the  short  span  of  a  few  hours,  which  is  the  limit 
of  life  to  most  organisms  so  imperfectly  developed  and 
the  nominal  existence  of  seventy  odd  years,  there  is  a 
wide  range,  any  part  or  even  the  whole  of  which  may 
be  attained  by  those  labouring  under  congenital  disease 
or  malformation  of  the  heart.  Of  course  the  larger  pro- 
portion of  those  with  congenitally  malformed  hearts  die 
within  the  first  few  years  of  infantile  life ;  still  a  certain 
proportion  linger  on  till  adult  life,  and  of  these  a  small 
percentage  attain  even  an  advanced  age ;  and  many  of 
those  who  reach  this  advanced  age  present  such  very 
evident  indications  of  there  being  something  wrong,  as 
help  to  prove  in  a  most  remarkable  manner  how  im- 
possible it  is  for  the  non-professional  eye  to  judge  of 
relative  imperfections  in  our  internal  organs,  or  to 
apportion  vitality  according  to  appearance.     Apart  from 


THE   HEART   AND   ITS    FUNCTION.  6 1 

these  congenital  defects,  the  heart  suffers  during  child- 
hood from  inflammatory  affections  attacking  the  chest, 
especially  when  the  left  side  is  affected,  many  cases  of 
disease  of  the  heart  being  apparently  traceable  to  such 
diseases  occurring  in  early  infancy.  Febrile  diseases,  of 
which  those  occurring  during  childhood  are  chiefly  of  the 
exanthematic  type,  such  as  measles  and  scarlet  fever, 
though  rheumatic  fever  also  occurs  even  in  infancy,  and 
other  diseases  such  as  whooping  cough,  are  all  capable 
of  more  or  less  seriously  damaging  the  heart,  and  con- 
valescence from  such  diseases  must  be  always  anxiously 
watched,  though  such  is  the  great  degree  of  vitality 
present  at  that  early  age  that  it  is  comparatively  seldom, 
except  in  the  case  of  rheumatism,  that  any  serious 
damage  is  incurred. 

After  the  sixth  birthday  the  period  of  youth  or  ado- 
lescence may  be  said  to  commence,  and  this  may  be 
regarded  as  continuing  to  the  twenty-fifth  year,  when  the 
frame  is  usually  set  and  the  long  plateau  of  middle  life 
commences,  which  might  itself  be  divided  into  three 
epochs — early  manhood  25-35,  middle  life  strictly  speak- 
ing 35-45,  and  commencing  age  45-55,  after  which  old 
age  may  be  regarded  as  beginning,  though  in  some  it 
advances  but  slowly. 

The  period  of  youth  is  that  which  is  fraught  with  most 
peril  for  the  heart,  those  who  have  escaped  the  exanthe- 


62  THE   HEART   AND    ITS    FUNCTION. 

mata  during  childhood  are  almost  sure  to  be  attacked  on 
commencing  scjiool  life ;  greater  exposure  increases  the 
risk  of  severe  rheumatic  attacks.  Chorea,  in  the  course  of 
which  the  heart  is  invariably  more  or  less  affected,  now 
for  the  first  time  invades  the  frame.  And  besides  all 
these,  we  have  the  serious  calls  made  on  the  constitution 
during  the  development  of  the  organism,  in  the  course  of 
which  the  heart  is  only  too  apt  to  suffer,  and  we  have  also 
a  certain  amount  of  risk  of  injury  to  the  heart  incurred 
during  those  gymnastic  exercises  in  which  youth  is  so 
prone  to  indulge. 

It  is  right  to  put  on  record  all  those  multifarious  forms 
of  disease  in  course  of  which  the  heart  is  apt  to  get 
damaged,  because  the  mere  cataloguing  of  them  may  be 
a  means  of  keeping  in  remembrance  evils  that  may  be 
consequent,  and,  by  directing  attention  to  the  possibility 
of  their  occurrence,  may  be  the  means  of  preventing  their 
unobserved  advance  to  an  irremediable  maturity.  But  it 
is  also  right  to  remember  that  all  these  ailments  by  which 
the  heart  is  damaged  can  only  hinder  the  due  perform- 
ance of  its  functions  by  injuring  the  perfection  of  its 
mechanism.  This  injury  to  the  mechanism  of  the  heart 
may,  however,  be  brought  about  in  two  ways :  first,  by 
injury  to  the  valves ;  and  second,  by  weakening  of  the 
cardiac  muscle,  and  this  weakening  of  the  cardiac  muscle 
may  itself  result  in  valvular  imperfection,  but  one  which 


THE    HEART   AND    ITS    FUNCTION.  63 

at  all  events  at  first  is  of  a  curable  character.  There  is 
but  one  disease  which  always  produces  incurable  valvular 
deformity,  and  that  is  endocarditis,  inflammation  of  the 
lining  membrane  of  the  hearty  and  this  may.  be  of  an 
acute,  subacute,  or  chronic  character ;  extremely  often  it 
originates  in  rheumatism,  sometimes  in  pregnancy,  very 
often  in  gout,  and  less  frequently  in  syphilis  and  injur}^ 
By-and-by  we  shall  consider  the  prophylaxis  of  these 
aff"ections. 

Debility  of  the  cardiac  muscle  is  a  much  more  frequent 
source  of  cardiac  discomfort^  and  a  much  more  common 
cause  of  actual  cardiac  disease,  than  is  supposed  by  most 
people,  and  though  fortunately  disease  thus  produced  is 
frequently  of  a  curable  character,  it  is  still  more  fortunate 
that  by  judicious  care  such  affections  can  be  to  a  large 
extent  wholly  prevented. 

All  affections  of  the  heart,  whether  curable  or  incurable, 
which  arise  from  debility  of  the  cardiac  muscle  ultimately 
resolve  themselves  into  what  is  termed  a  heart-strain. 
When  any  muscle  is  called  upon  to  make  an  exertion 
greater  than  it  is  capable  of,  it  is  either  strained  or  rup- 
tured ;  a  strain  involves  of  course,  as  we  all  know,  incapa- 
city for  perfect  contraction  for  some  time,  and  to  a  hollow 
muscle  like  the  heart  this  of  course  involves  dilatation. 
So  that  a  greater  or  less  degree  of  dilatation  of  the  heart 
is  the  natural  result  of  every  heart-strain,  however  slight 
5 


64  THE    HEART   AND    ITS    FUNCTION. 

A  heart-Strain  may  arise  from  violent  over-exertion  at  any 
age,  and  is  usually  more  or  less  serious,  according  to  the 
age  of  the  individual ;  serious  in  its  immediate  as  well 
as  in  its  ultimate  results. 

What  we  call  fatigue  is  merely  an  indication  that  the 
muscles  want  rest ;  the  transformation  of  energy  has 
been  so  great,  and  so  continuous,  that  the  ordinary  blood 
supply  is  insufficient  to  keep  it  up  at  the  same  rate  ;  the 
muscle  must,  therefore,  rest,  and  it  indicates  this  to  the 
consciousness  of  the  individualby  sending  through  its 
sensory  nerves  a  feeling  of  fatigue  to  the  sensorium.  The 
heart  never  gives  any  indication  of  fatigue  beyond  an 
excited  and  laboured  action ;  but,  if  violent  exercise  be 
continued  after  this  indication  is  given,  the  overladen 
heart  gets  over-distended,  sends  an  insufficient  supply  of 
blood  to  the  brain,  and  the  victim  falls  to  the  ground,  in- 
capable of  any  exertion  greater  than  that  involved  in  the 
bare  maintenance  of  life.  This  sudden  heart-strain  may 
follow  any  violent  exertion,  such  as  running,  rowing,  or 
lifting  heavy  -weights  ;  and,  after  middle  life,  when  the 
tissues  of  most  people  begin  to  deteriorate,  the  results 
may  be  very  disastrous,  and  even  fatal.  A  similar  acci- 
dent may  also  occur  in  early  hfe,  but  seldom,  and  it  is 
rarely  serious  in  its  character  at  that  age.  But  in  a  lesser 
degree,  and  of  slower  development,  heart-strains  are  a 
very  common  source  of  cardiac  discomfort  in  early  life, 


THE   HEART  AND    ITS    FUNCTION.  65 

and  may  even  end  in  the  development  of  serious  disease. 
This  is  one  of  the  risks  to  which  young  and  growing 
lads  are  exposed  when  they  engage  in  athletic  sports 
without  due  preparation,  and  it  is  town-bred  lads  who 
are  most  apt  to  suffer  in  this  way.  A  country  boy  is 
always  on  the  move ;  his  tissues  are  thoroughly  nourished 
and  well  developed,  and  his  blood  is  full  of  oxygen,  so 
that  he  is  well  prepared  for  any  exertion.  A  town-bred 
boy,  on  the  other  hand,  has  his  muscles  less  fully  deve- 
loped ;  his  blood  contains  less  oxygen,  and  there  is  more 
fat  about  him  ;  he  more  easily  gets  blown  and  fatigued  ; 
he  therefore  runs  a  greater  risk  of  heart-strain  on  first 
commencing  football,  cricket,  or  rowing,  than  the  more 
fortunate  denizen  of  the  country,  simply  because  his 
cardiac  muscle  is  weak,  and  therefore  unfitted  to  resist 
the  strain  thrown  on  it.  But  all  this  can  be  put  right  by 
a  little  judicious  care  on  the  part  of  those  in  charge  to 
see  that  the  youthful  enthusiasm  of  the  boy  is  restrained 
until  by  gradual  training  he  has  become  fitted  for  taking 
part  with  his  fellows.  Perhaps*  in  these  days  it  is  even 
more  necessary  to  put  in  a  plea  for  the  girls,  that  they 
should  not  be  permitted  to  injure  themselves  by  desultory 
over-exertion.  A  girl  who  perhaps  never  brushes  her 
own  hair,  or  is  tired  to  death  with  doing  it,  is  yet  per- 
mitted to  ride  till  over-fatigued,  perhaps  as  a  means  of  re- 
freshment after  dancing  half  the  night ;  to  skate  all  day, 


66  THE    HEART   AND    ITS    FUNCTION. 

or  to  play  lawn  tennis,  not  always  on  a  lawn  and  in  the 
open  air,  and  to  carry  it  on  far  too  long  in  all  the  excite- 
ment of  a  match.  Can  we  wonder  that  hearts  so  over- 
excited get  strained,  dilated,  or  irritable,  and  that  the 
very  means  intended  to  promote  health  and  strength 
become  a  source  of  weakness  and  disease  from  which  re- 
covery is  always  tedious,  because  the  exertion  is  desultory 
and  excessive.  No  man  would  permit  his  racehorse,  his 
greyhound,  or  even  his  pointer,  to  be  so  abused ;  is  his 
daughter  or  sister  of  less  value,  or  are  human  frames 
built  upon  different  principles  from  those  of  other 
animals?  It  is  well  to  remember,  too,  that  similar 
causes  have  similar  results  at  any  age,  and  that  when 
a  city  merchant,  a  lawyer,  or  a  member  of  any  other  pro- 
fession, leads  a  sedentary  life,  or  at  least  one  of  com- 
parative inaction  during  ten  months  in  •  the  year,  and 
goes  North  to  his  deer  forest  or  his  grouse  moor  for  the 
other  two,  he  does  so  at  considerable  personal  risk.  A 
comparatively  young  man  of  good  constitution,  who  has 
been  in  early  life  a  public  schoolboy  and  accustomed  to 
indulge  freely  in  all  the  usual  athletic  sports  of  school  life, 
and  has  lived  temperately,  runs  the  least  risk.  Even  for 
him  these  risks  gradually  increase,  and  after  middle  life 
are  very  considerable,  and  they  are  largely  augmented  by 
habits  of  self-indulgence,  or  by  the  presence  of  a  gouty 
or  other  depraved   habit  of  body,  especially  if  that  be 


THE   HEART  AND    ITS    FUNCTION.  67 

hereditary.  And  the  risk  is  not  so  much  one  of  the 
sudden  development  of  serious  heart-strain,  though  that 
too  is  not  impossible^  but  rather  consists  in  the  starting 
of  a  form  of  heart-strain  of  slower  development,  though 
of  not  less  serious  character,  which  is  but  the  beginning 
of  the  end.  Every  man,  therefore,  who  is  not  in  training, 
that  is,  who  does  not  walk  smartly  at  least  ten  miles  daily 
— and  mere  hanging  on  the  feet  or  dawdling  along  the 
street  counts  for  nothing  in  this  respect,  however 
fatiguing  they  may  be — ought  to  be  specially  careful 
when  he  commences  his  work  on  his  moor,  even  if  he 
be  under  middle  age ;  while  if  he  be  over  middle  age 
he  ought  not  only  to  be  specially  careful,  but  he  ought 
also  to  take  medical  advice  as  to  the  state  of  his  circu- 
latory system,  before  he  ever  dreams  of  any  sport  higher 
than  a  battue,  or  its  analogue,  a  grouse  drive.  Ancl  of 
course  the  same  remarks  are  applicable  to  any  other  form 
of  violent  exercise  only  occasionally  indulged  in  during 
intervals  of  leisure,'  whether  the  special  form  be  Alpine 
climbing,  salmon  fishing,  rowing,  or  cricket.  The  risk 
consists  in  the  occasional  character  of  the  indulgence 
far  more  than  in  the  form  of  exercise,  and  it  is  largely 
increased  even  by  the  use,  and  still  more  by  the  abuse,  of 
alcohol  and  tobacco,  which  have  a  direct  enfeebling 
action  on  the  heart  -that  may  be  seriously  injurious 
unless  kept  in    the   strictest  moderation.      It    is    well, 


68       •  THE   HEART   AND    ITS    FUNCTION.    . 

too,  to  remember  that  a  mistake  in  early  life,  if  taken 
in  time  is  easily  recovered  from,  but  the  older  one 
grows  the  more  difficult  this  becomes,  imtil  a  period 
arrives  when  all  we  can  do  is  to  put  on  the  drag  so  as  to 
delay  as  much  as  possible  the  approach  of  the  inevitable 
end.  This  period  comes  early  to  some,  even  before 
middle  life ;  to  most  it  arrives  about  middle  life  or  in 
early  age,  while  there  are  a  very  few  exceptional  indi- 
viduals who  never  seem  to  age  at  all  as  regards  their 
circulatory  system,  and  who  die  apparently  from  accident 
often  at  a  very  advanced  period  of  life. 

There  is  also  another  danger  to  which  the  young  are 
liable,  even  when  care  is  taken  that  no  undue  risk  is  run 
in  commencing  athletics,  and  that  is  in  making  them  too 
violent  and  continuing  them  too  long  so  as  to  develop  an 
enlargement  or  hypertrophy  of  the  heart.  This  is  not  of 
frequent  occurrence,  and  as  a  rule  on  giving  up  athletics 
it  gradually  dies  off,  and  the  heart  returns  to  its  former 
condition. 

Some,  however,  of  the  most  serious  affections  of  the 
heart  in  the  young  are  apt  to  come  on  in  a  most  dan- 
gerous and  insidious  manner  from  malnutrition  ;  both 
sexes  are  liable  to  disease  arising  in  this  way,  coming  on 
either  after  one  or  other  of  the  febrile  diseases  of  child- 
hood, or  arising  from  simple  exhaustion  due  to  defective 
nourishment   of  the   body  during  the   development   of 


THE  HEART  AND  ITS  FUNCTION.         69 

puberty;   and   in  this  respect  the   female   sex   are  the 
greatest  sufferers.     Having  learned  the  amount  of  work 
that  the  heart  has  to^o,  we  can  readily  understand  that 
it  suffers  greatly  from  any  interference  with  the  general 
nutrition  of  the  body.     If  the  external  muscles  of  the 
body  are  wasted  and  flabby,  the  heart  cannot  but  be 
more  or  less  limp  and  flaccid,  and  any  loss  of  tone  is 
immediately   followed    by    some    degree    of  change    of 
structure :  early  recognised  and  taken  in  time  this  may 
be  of  no  consequence,  but  if  neglected,  serious  and  in- 
curable diseases  may  be  the  result.     How  often  is  this 
the  case  !  some  delicate  girl  has  been  encouraged  to  go 
about  when  quite  unfit  for  exertion,  with  the  view  of 
improving   her   health,   and   the   result   has   been  that, 
warned  by  a  greater  degree  of  breathlessness  than  usual, 
or  by  some  unwonted  puffiness  of  the  ankles,  her  friends 
have  at  last  taken  medical  advice,  and  well  it  is  for  her 
if  they  be  not  too  late.     Even  yet,  with  all  our  advances 
in  the  knowledge  of  morbid  processes  and  their  treatment, 
too  late  is  still  a  possibility ;  how  many  such  cases  were 
formerly  allowed  to  lapse  into  incurability  it  is  impossible 
to  say  j  many  did  so,  fortunately  not  all,  for  in  the  spring- 
time of  our  life  there  are  but  few  of  what  we  may  call 
the  nutritional  diseases  which  may  not  be  thrown  off  by 
a  moderately  robust  constitution  under  favourable  circum- 
stances.    But  there  is  equally  little  reason  to  doubt  that 


7Q  THE   HEART   AND    ITS    FUNCTION. 

judicious  treatment  is  able  to  shorten  the  period  of  risk 
even  for  these  favourable  cases,  as  well  as  to  rescue  many 
others  from  life-long  misery.  Help  in  time  is  certainly 
able  to  relieve  much  uneasiness,  to  lessen  the  risk  of  the 
affection  becoming  incurable,  and  in  the  worst  cases  it 
will  greatly  improve  the  health  of  the  sufferer  and  prolong 
his  life.  The  watchful  care  of  the  parent  should  not, 
however,  wait  till  the  heart  is  actually  affected  before  it 
takes  alarm ;  the  olden  motto,  obsta  principiis — withstand 
beginnings — of  evil  especially,  should  be  remembered, 
and  the  first  indications  of  failing  health  ought  to  sound 
a  note  of  warning  to  be  acted  on  at  once.  Pallor, 
languor,  failure  or  capriciousness  of  appetite,  or  any 
inability  for  the  ordinary  enjoyments — to  say  nothing  of 
the  labours — of  life,  ought  always,  but  especially  in  young 
people,  to  be  regarded  as  important  indications  of  a 
failure  of  health,  the  cause  of  which  should  be  most  care- 
fully investigated  and  remedied.  If  this  be  not  done  at 
once,  the  best  that  can  happen  is  the  production  of  an 
impoverished  condition  of  blood,  a  weakened  and  more 
or  less  incompetent  heart,  an  enfeebled  frame,  and  a 
delicacy  of  constitution  which  may  last  for  years,  and 
which,  if  not  detected  and  remedied,  may  not  only  lay 
the  foundation  for  serious  organic  disease,  but  may  also 
give  serious  or  even  fatal  efficacy  to  any  accidental 
ailment  which  may  attack  the  patient  in  the  meantime. 


THE   HEART   AND    ITS    FUNCTION.  7 1 

How  often  do  we  hear  it  said,  "  Oh,  there  is  nothing 
wrong;  the  heart  is  only  a  httle  weak,  or  the  blood  a 
little  poorer  than  it  ought  to  be ; "  words  apparently  of 
but  little  moment,  but  of  ominous  import  to  those  who 
know  that  the  integrity  of  every  function  of  the  body 
depends  upon  the  maintenance  of  a  due  amount  of  intra- 
arterial blood  pressure,  and  on  the  quality  of  the  circu- 
lating fluid.  For  the  heart  is  an  organ  which  rests  only 
in  sections,  and  for  fractions  of  a  second  at  a-  time.  .  The 
work  done  by  it  is  not  only  continuous,  but,  relative  to 
its  size,  it  is  greater  than  that  of  any  steam  engine  in  thq 
world.  Unless,  therefore,  it  is  kept  in  the  most  perfect 
repair,  the  mere  strain  of  its  own  work  is  too  much  for  it ; 
it  becomes  mechanically  unfit  for  the  discharge  of  its 
function,  and  we  have  all  the  untoward  results  which  flow 
frSm  such  a  state  of  matters.  The  heart,  'however,  is 
kept  in  repair  by  the  blood,  which  removes  its  waste  and 
supplies  it  with  fresh  material.  But  if  the  blood  is  in  any 
respect  poor  or  imperfect  in  quality,  all  the  organs  of  the 
body  suffer  in  their  nutrition  and  in  the  energy  with 
which  their  functions  are  discharged ;  and  the  heart 
suffers  earliest  of  all,  because  of  the  nature  and  amount 
of  work  it  has  to  do.  Poor  blood  thus  means  a  weak 
heart,  and  that  involves  the  imperfect  discharge,  not  only 
of  the  heart's  own  function,  but  of  all  the  other  functions 
of  the  body,  one  result  of  this  being  the  reproduction  of 


72  THE   HEART  AND   ITS   FUNCTION, 

poor  blood.  We  are  thus  in  the  midst  of  a  vicious  circle, 
from  which  the  organism  cannot  free  itself  without 
extraneous  help,  and  though  that  help  may  be  given  in 
various  ways,  it  is  most  surely  attained  through  the  wise 
counsel  of  a  skilful  physician.  But  though  impoverished 
blood  and  a  weak  heart  may,  and  occasionally  do,  result, 
when  neglected,  in  permanent  cardiac  disease,  they  are 
even  more  serious  from  the  lowered  vitality  of  the 
organism  which  they  induce,  a  condition  which  not 
only  causes  many  influences  to  prove  injurious  which 
,would  otherwise  be  harmless,  but  which  makes  the 
organism  less  able  to  cope  with  any  injuries  it  may 
receive,  and  more  liable  to  succumb,  and  which,  even 
at  the  best,  deprives  it  of  that  bodily  and  mental 
energy  needful  to  ensure  success  in  the  battle  of  life. 
The  healthj  the  bodily  comfort,  and  the  future  success 
in  life,  all  therefore  require  that  careful  attention  be 
paid  to  the  maintenance  of  a  stout  heart  and  good 
blood  in  the  rising  generation,  for  without  these  there 
is  neither  any  certain  health  possible  nor  any  sure  success 
attainable. 

It  is  not  always  very  easy  to  say  what  is  the  beginning 
of  all  this  evil,  there  are  so  many  various  ways  in  which 
constitutional  exhaustion  may  commence,  all  of  them 
insidious  and  growing  apace,  though  too  often  un- 
markedly,  till  suddenly  a  breakdown  occurs,  and  then  the 


THE   HEART  AND    ITS    FUNCTION.  .73 

heart   is   certain  to  be   found  affected,  fortunately   not 
incurably  so,  except  in  a  small  minority  of  cases. 

It  has  been  already  pointed  out  (p.  8)  that  every  act 
evincing  life  is  the  result  of  the  transformation  of  poten- 
tial into  kinetic  energy,  and  that  the  object  of  the 
circulation  is  to  remove  waste  and  provide  for  such  a 
renewal  of  tissue  and  of  oxygen  as  to  maintain  the 
normal  amount  of  potential  energy  within  the  organism. 
To  maintain  this  standard  of  vitality,  the  income  of  the 
body  must  at  least  equal  its  expenditure,  otherwise 
bankruptcy  of  health  will  as  surely  follow  as  would 
bankruptcy  of  means  a  similar  state  in  regard  to  money 
matters.  By  the  inco7iie  of  the  body  is  meant  all  that  the 
body  receives  in  the  shape  of  food,  drink,  and  oxygen  in 
the  course  of  the  day,  while  the  expenditure  is  of  course 
the  waste  incurred  in  the  transformation  of  energy.  This 
may  be  calculated  from  the  various  excretory  products  of 
the  body,  and  has  been  thus  ascertained  to  be  for  a 
healthy  adult  between  seven  and  ten  pounds  in  the 
twenty-four  hours,  including  solids,  fluids,  and  gaseous 
matter  (oxygen).  To  provide  for  this  waste,  which 
consists  almost  wholly  of  oxidised  material  in  solution, 
a  similar  amount  of  unoxidised  material,  with  sufficient 
water  for  its  solution,  must  be  supplied  through  the 
stomach,  and  an  appropriate  amount  of  oxygen  through 
the   lungs.     There  is  no   difficulty  about   the   oxygen  ; 


74  THE   HEART   AND    ITS    FUNCTION. 

that  is  supplied  by  the  air  by  the  natural  process  of 
respiration,  the  cessation  of  which  is  productive  of  such 
disagreeable  results  as  are  never  voluntarily  endured  for 
long.  But  the  ingestion  of  the  solids  and  fluids  necessary 
for  our  maintenance  is  so  dependent  on  our  own  will  as 
to  lead  to  the  most  extreme  variations,  both  in  regard  to 
excess  and  deficiency,  and  each  of  .these  extremes  is 
productive  of  very  injurious  results  on  the  heart,  and 
through  it.  on  the  system  at  large.  If  our  income  just 
balances  our  expenditure,  this  has  a  very  different  sig- 
nification at  different  stages  of  life  ;  at  all  periods  it 
means  a  precarious  hand-to-mouth  life,  without  a  margin 
to  draw  upon  in  case  of  illness.  In  youth,  when  the 
body  is  being  developed,  a  defective  income,  that  is  one 
no  larger  than  the  expenditure,  signifies  even  more.  It 
signifies  defective  growth,  and  as  the  result  of  that,  an 
ailing  life,  which  may,  if  not  remedied,  terminate  in 
irremediable  disease.  In  middle  life  and  old  age  we 
have  no  further  development  to  provide  for,  but  neither 
have  we  that  to  draw  bills  upon.  Our  expenditure  dare 
not  therefore  be  so  great  in  relation  to  our  income  as  in 
youth.  And  if  we  have  no  margin  of  potential  energy 
laid  up  in  store,  we  readily  suffer  from  a  thousand  ills, 
which  are  utterly  harmless  to  a  man  with  a  margin ;  and 
though  our  future  may  not  suffer,  our  present  is  always 
more  or  less  precarious.     There  is  no  longer  any  risk 


THE   HEART   AND    ITS    FUNCTION.  75 

of  stunted  development,  but  any  accident  may  suffice 
to  fatally  lower  a  blood  pressure  already  only  at  par. 
For  a  healthy  adult  man  taking  full  exercise,  a  diet 
consisting  of  2  J  lbs.  of  soHd  food,  of  which  from  f  lb.  to 
I  lb.  may  be  animal  food,  and  three  pints  of  liquid — 
water,  cocoa,  or  tea — is  amply  sufficient;  while,  though 
some  certainly  do  live  and  maintain  an  appearance  of 
health  upon  much  less,  yet  twenty-four  ounces  of  solids 
may  be  reckoned  the  lowest  limit  even  for  those  who  do 
nothing  but  beg,  v/hile  for  those  who  actively  work  the 
amount  must  be  considerably  increased.  It  has  long  been 
known  that  those  who  are  starved  are  not  long  of  losing 
their  sense  of  hunger,  because  exhaustion,  however  it  may 
arise,  blunts  every  sense,  hunger  amongst  the  rest ;  but  we 
seldom  reflect  that  though  starvation  is  a  relative  term, 
it  may  have  a  similar  effect,  however  it  may  be  brought 
about,  and  yet  it  is  needful  to  remember  this,  for  it  has 
a  most  important  significance.  Youth  is  the  period 
of  superfluous  energy,  but  it  is  also  the  time  when 
growth  is  going  on,  to  provide  for  which  we  require  an 
excess  of  nutritive  material,  part  of  which  is  tem- 
porarily stored,  providing  that  excess  of  potential  energy 
just  referred  to;  but  if  we  waste  this  needful  excess 
in  undue  indulgence  in  athletic  sports,  even  in  such 
apparently  mild  forms  as  in  taking  too  long  walks,  in 
over-much   brainwork,    or    in    excessive    emotion,    our 


76  THE    HEART   AND    ITS    FUNCTION. 

expenditure  becomes  relatively  greater  than  our  in- 
come, and  all  the  results  of  starvation  speedily  follow. 
Amongst  these  are  a  greater  or  less  loss  of  appetite, 
blunting  of  the  sensation  of  hunger,  either  an  absolute 
disinclination  for  food  or  drink,  or,  at  all  events,  such 
an  aberration  of  the  sense  of  hunger  as  leads  those 
afflicted  with  it  to  fill  their  stomachs  with  whatever  they 
may  fancy,  however  indigestible,  rather  than  with  whole- 
some food.  The  result  of  this  is  easily  foreseen,  the  com- 
position of  the  blood  is  speedily  and  materially  altered 
for  the  worse,  and  of  course  the  heart  quickly  suffers,  and 
with  it  the  whole  organism.  It  is  only  by  slow  degrees 
that  all  these  important  changes  occur,  and  although 
when  once  they  are  fully  developed  and  attract  attention 
it  may  be  impossible  to  carry  their  history  backwards 
farther  than  a  few  weeks,  yet  we  may  be  assured  that  the 
progress  of  such  affections  is  very  slow,  and  as  it  is  also 
comparatively  easily  checked  at  first,  those  in  charge 
of  young  people  ought  to  be  very  watchful.  We  are  so 
apt  to  regard  joy  or  sorrow  as  mere  feelings  that  we 
forget  that  these  feelings  have  a  physical  basis,  and  that 
their  perception  is  an  expenditure  of  force.  Grief,  too, 
has  a  depressing  influence  of  itself,  which,  as  we  all  know, 
takes  away  our  appetite,  and  when  to  this  loss  of  income 
we  add  the  additional  expenditure  occasioned  by  those 
sensations   by  which   we  recognise   its   existence,   and 


THE   HEART  AND    ITS    FUNCTION.  ^^ 

reflect  upon  the  consequence  of  a  disturbance  of  the 
proper  relation  between  income  and  expenditure  upon 
the  constitution  of  the  blood,  and  through  that  upon  the 
heart,  we  know  that  the  poetical  phrase  "  a  broken 
heart"  is  no  mere  fiction,  but  merely  an  exaggerated 
statement  of  what  actually  occurs,  the  term  "o'erfraught 
heart "  being  strictly,  and  even  pathologically,  correct. 
But  excessive  emotion  is  not  the  only  expenditure  of 
nervous  force  in  regard  to  which  we  should  be  watchful. 
Over-study  is  a  more  widespread  and  destructive  evil, 
and  in  these  days  of  competitive  examinations  it  is  a 
most  destructive  one.  While  the  idea  of  counteracting 
the  evil  effects  of  prolonged  brainwork  by  a  bout  of 
violent  athletics  is  one  arising  out  of  the  notion  that 
brainwork  is  no  expenditure  of  income,  but  merely  a' 
nervous  excitement,  mainly  injurious  by  its  preventing 
the  working  off  of  that  food  which  our  stomach  insists 
upon  having.  The  moment,  however,  that  we  realise 
that  brainwork  is  as  great,  and  in  some  respects  a 
greater,  expenditure  of  income  (food)  than  muscular 
exercise,  then  we  comprehend  that  to  counterbalance 
prolonged  brainwork  by  violent  exercise  is  to  burn  the 
candle  at  both  ends^  and  is  as  certain  of  producing  bank- 
ruptcy of  health  as  the  latter  figurative  procedure  when 
exercised  in  regard  to  money  matters  is  of  producing  a 
similar  condition  financially.     It  is  a  most  important  fact 


78  THE    HEART   AND    ITS    FUNCTION. 

to  remember,  that  all  emotions,  such  as  grief,  imrequited 
aftection,  and  all  over-exertion,  either  of  mind  or  body,  all 
of  which  are  equivalent  to  excessive  expenditure,  may 
produce,  eveti  amidst  abundance — and  it  is  this  which  it  is 
important  to  remember —  all  the  effects  oif  starvation,  and 
the  result  of  that  is  not  hunger.  Dr.  Kane  says  :  "  It  is 
curious  that  the  effect  of  short  allowance  does  not  show 
itself  in  hunger.  The  first  symptom  is  a  loss  of  power, 
often  so  imperceptibly  brought  on  that  it  becomes 
evident  only  by  accident."  And  a  mechanic,  when 
asked  how  the  children  got  on  during  the  cotton  famine, 
stated,  as  part  of  his  reply,  *'  When  their  blood  got  thin, 
puir  craturs,  they  were  a  mair  easily  pleased,  for  they 
didna  feel  sae  hungry." 

Remember,  then,  that  excess  of  expenditure  over  in- 
come, however  produced,  by  excessive  emotion,  mental  or 
bodily  exertion,  always  results  in  impoverishment  of  the 
blood  ;  that  this  is  speedily  followed  by  impairment  of  the 
heart's  structure  and  of  its  function,  as  well  as  by  general 
degradation  of  the  organic  health,  which  lays  us  open  to 
a  thousand  ailments,  and  is  specially  apt  to  result  in 
organic  disease  of  the  heart.  And  we  must  never  forget 
that  in  the  world  of  Hygeia,  as  well  as  in  that  of  finance, 
the  care  for  apparent  trifles  results  in  the  accumulation 
of  a  reserve  of  potential  energy,  and  that  one  of  the 
greatest  obstacles  to  improvement  is  to  be  found  in  the 


THE    HEART   AND    ITS    FUNCTION.  79 

obstinate   lAanner    in   which   the   organism   persists   in 
ignoring  its  own  danger. 

Those  affections  of  the  cardiac  function  dependent  upon 
spanaemia,  or  impoverished  blood,  are  all  curable  if  taken 
in  time  and  properly  treated ;  they  are  therefore  usually 
called  functional,  as  if  they  related  only  to  the  function  of 
the  heart,  and  did  not  also  implicate  its  structure.  But 
we  know  now-a-days  that  the  physical  signs  upon  which 
we  rely  for  the  detection  of  these  affections  have  always 
a  similar  physical  basis,  whether  the  affection  is  curable 
or  not,  and  we  employ  the  word  functional  only  as  an 
indication  of  our  opinion  of  the  curable  nature  of  the 
disease.  Functional  diseases  of  the  heart  are  all  diseases 
of  early  life,  only  occurring  exceptionally  after  adult  life 
has  been  fully  attained,  and  only  rarely,  and  when  neg- 
lected, giving  rise  to  serious  organic  mischief  The  most 
frequent  cause  of  organic  disease  of  the  heart  is,  however, 
also  a  disease  of  youth — Rheumatism.  In  our  ignorance 
we  no  doubt  include  under  this  head,  that  is  to  say,  we 
are  apt  to  refer  to  some  unknown  preceding  attack  of 
rheumatism,  many  cases  of  organic  disease  of  the  heart 
which  have  really  originated  in  non-rheumatic  inflam- 
matory attacks  of  a  chronic  or  subacute  character,  but 
even  after  making  a  large  allowance  for  such  mistakes, 
rheumatism  is  still  \t.i\.  facile ^rinceps  as  the  curse  of  man- 
kind so  far  as  disease  of  the  heart  is  concerned.  And  it 
6 


8o  THE    HEART  AND    ITS    FUNCTION. 

is  specially  so  in  this,  that  it  is  not  a  wastedfor  worn-out 
life  which  it  shortens,  possibly  mercifully,  but  it  is  the 
young,  the  strong,  and  the  apparently  healthy  that  it 
seizes  upon,  and  forthwith  poisons  all  their  springs  of  life. 
It  is  truly  sad  to  see  mere  children  in  all  the  innocence 
of  childhood,  young  men  and  maidens  in  all  the  beauty 
and  the  pride  of  youth,  crippled  by  the  fell  destroyer, 
not  killed  but  scotched,  and  doomed  to  lead  henceforth  a 
lingering  life  in  death.  This,  however,  is  rather  the  pro- 
fessional aspect ;  to  the  sufferers  themselves  the  case  for 
the  most  part  seems  neither  so  sad  nor  so  hopeless.  Some 
no  doubt  suffer  greatly,  but  many  get  along  not  only 
pretty  fairly,  but  Avithout  any  conscious  embarrassment 
for  many  years,  liable  no  doubt,  as  we  all  are,  but 
such  sufferers  in  a  much  higher  degree,  to  sudden  death, 
yet  fully  able  to  enjoy  life  like  their  neighbours  till  a 
period  comes  when  the  dynamic  compensation  fails  and 
*'  earth  goeth  to  his  earth,  sooner  than  it  would,"  or  ought. 
What  proportion  exists  between  those  who  suffer  greatly 
and  die  early,  and  those  who  make  out  without  discomfort 
a  fair  proportion  of  their  span,  is  as  yet  unknown ;  but, 
be  this  as  it  may,  there  can  be  no  doubt  that  if  w*e  could 
annihilate  rheumatism  we  should  prevent  an  almost  in- 
calculable amount  of  misery  and  suffering  arising  from 
secondary  disease  of  the  heart.  Even  by  shortening  the 
duration  of  the  attack  we  do  something   towards   this 


THE  HEART  AND  ITS  FUNCTION.         St 

prevention,  though  not  all  that  could  be  desired.  Modem 
physic  has  taken  a  great  step  in  this  direction ;  but  un- 
fortunately implication  of  the  heart  is  so  often  an  early 
complication  of  this  disease  that  the  speediest  cure  could 
not  totally  prevent  its  occurrence,  consequently  our  only 
hope  of  this  lies  in  the  total  extinction  of  thfe  disease.  A 
hopeless  task,  some  may  say,  to  seek  to  extinguish  rheu- 
matism ;  but  many  diseases  have,  during  the  lapse  of  ages, 
apparently  changed  their  character,  and  some  have  died 
completely  out,  and  why  should  rheumatism  prove  any 
exception  ?  Why  should  the  science  of  the  nineteenth  or 
the  twentieth  century  be  unable  to  do  for  rheumatism 
what  chance  and  haphazard  have  done  for  other  diseases 
during  former  ages?  Unfortunately  so  little  is  known 
about  the  actual  causes  of  this  disease  that  as  yet  we 
scarcely  know  where  to  begin.  If  we  were  to  follow  the 
popular  view,  all  that  seems  to  be  needful  is  only  to  avoid 
cold  and  damp,  to  clothe  warmly,  feed  well,  and  secure  a 
dry  and  comfortable  house,  and  we  have  done  all  that  is 
possible.  But  those  who  know  that  the  class  who  suffer 
most  from  rheumatism  are  young  servant  girls,  brought 
from  running  half  wild  on  the  hillsides  to  a  warm,  com- 
fortable town  house,  and  from  the  scanty  fare  of  their 
cottage  home  to  the  plentiful  and  even  luxurious  table  of 
the  servants'  hall,  may  be  permitted  to  doubt  if  warmth 
and  good  feeding  are  the  only  requisites  to  ensure  immu- 


82  THE    HEART   AND    ITS    FUNCTION. 

nity  from  rheumatism.  And  this  doubt  is  not  lessened 
when  we  find  that  Dr.  Haviland  in  his  great  work  on  the 
*  Geographical  distribution  of  heart  diseases  and  dropsy  in 
England  and  Wales,'  *  points  out  that  those  districts  which 
have  the  lowest  mortality  from  such  diseases  are  amongst 
the  most  open  and  exposed  in  the  whole  country,  while 
many  of  those  districts  in  which  the  mortality  from  such 
causes  is  highest  are  the  most  sheltered  spots  in  the 
country — valleys  to  the  leeward  of  sheltering  ranges  of 
hills,  or  towns  with  streets  so  constructed  that  no  rude  or 
boisterous  blast  shall  penetrate  them.  Dr.  Haviland  has 
published  a  large  map  exhibiting  in  divers  colours  those 
districts  having  the  highest  and  those  having  the  lowest 
mortality  from  heart  disease  and  dropsy,  presumably  of 
rheumatic  origin,  as  ascertained  by  his  own  inquiries  in 
relation  to  236,983  deaths  occurring  during  the  decade 
1851-60.  And  he  recommends  those  convalescing  from 
rheumatism  to  avoid  all  those  localities  having  a  high 
death  rate  from  heart  disease,  when  they  are  selecting  a 
place  for  change  of  air;  and  he  also  advises  all  those 
whose  family  history  indicates  a  proclivity  to  rheumatism 
to  choose  for  their  permanent  residence  such  localities 
and  districts  as  experience  has  shown  to  have  a  low 
mortality  from  the  secondary  results  of  this  disease, 
if  they  wish  to  avoid  evoking  a  disease  to  which  their 

*  London,  1875.     Smith,  Elder,  &  Co. 


THE  HEART   AND   ITS    FUNCTION.  S$ 

constitutions  are  already  only  too  prone.  To  gain 
immunity  from  rheumatism,  were  it  possible  to  do  so, 
would  be  worthy  of  almost  any  sacrifice,  as  it  is  a  disease 
which  mainly  attacks  the  young,  and  so  often  cripples 
the  very  citadel  of  life  as  to  poison  all  its  springs  when  it 
does  not  actually  cut  it  short.  Still  it  is  not  possible 
for  many  of  us  to  pitch,  our  tent  in  this  or  that  locality ; 
our  place  of  residence,  so  far  at  least  as  a  town  or 
a  district  is  concerned,  is  too  often  selected  for  us  by 
circumstances  over  which  we  have  little  if  any  control, 
so  that  all  that  is  left  for  us  to  do  is  simply  to  imitate, 
as  far  as  possible  in  regard  to  our  actual  dwelling, 
those  climatic  conditions  which  have  been  found  to 
be  most  favourable  to  immunity  from  rheumatic  affec- 
tions.. These  have  been  found  to  be,  free  exposure  to 
the  winds,  especially  such  as  are  sea-winds,  as  by  this  free 
flushing  the  air-sewage,  which  may  be  both*  of  animal  and 
of  vegetable  origin,  is  not  only  driven  off,  but  also  to  some 
extent  probably  neutralised  by  the  chemical  action  of  the 
ozone  so  largely  contained  in  sea-air.  We  must,  there- 
fore, in  our  selection  of  a  house,  endeavour  to  procure 
an  elevated,  dry,  gravelly  site,  freely  iexposed  to  the  wind, 
or  which,  at  all  events,  is  so  situate  that  it  can  be  freely 
ventilated,  and  we  must  be  careful  to  give  those  airs, 
fraught  with  blessing,  free  access  to  our  living  and 
sleeping  apartments,  and  in  doing  so  we  must  avoid  the 


84  THE    HEART   AND    ITS   FUNCTION. 

two  evils  of  chilling  the  rooms  and  producing  draughts, 
both  of  which  would  certainly  be  injurious  to  the  in- 
habitants, but  both  of  which  are  quite  easily  avoided. 
These,  however,  are  matters  of  detail ;  but  it  is  well  to 
remember  that  they  are  not  only  very  important,  but 
also  perfectly  attainable.  While  thus  attending  as  far  as 
possible  to  the  rem^oval  of  what  has  been  aptly  termed 
air-sewage,  we  must  also  see  that  the  drains  are  perfect, 
and  thoroughly  disconnected  with  the  house,  so  that  all 
contamination  from  that  cause  is  impossible;  and  we 
must  also  secure  an  abundant  supply  of  pure  and  whole- 
some water,  as  perhaps  as  important  an  agent  in  the 
preservation  of  health  as  fresh  air  itself.  Few  people  are 
aware  how  important  an  agent  pure  water  is,  but  if  we 
reflect  that  every  act  of  life  consists  in  the  oxidation  of 
the  material  of  which  our  body  is  composed,  that  this 
oxidised  material  must  be  dissolved,  floated  off,  and 
thrown  out  of  the  system  in  solution,  while  at  the  same 
time  fresh  unoxidised  material  must  be  floated  into  the 
body  to  replace  what  is  thrown  out,  then  we  can  under- 
stand the  importance  of  an  abundant  supply  of  pure 
water,  which  removes  the  effete  material  from  our  blood, 
where  it  is  even  more  likely  to  prove  injurious  than  in 
our  drains.  We  can  also  do  a  great  deal  to  secure  the 
purity  of  our  blood  from  effete  material  by  moderate 
living;  for  some  individuals  there  seem  to  be  certain 


THE   HEART  AND    ITS    FUNCTION.  85 

special  articles  of  diet  which  apparently  have  an  important 
effect  in  inducing  or  keeping  up  a  tendency  to  rheumatism; 
animal  food  is  one  of  these,  especially  if  taken  in  excess, 
milk  and  fish  having  the  least  rheumatic  tendency  of  all 
such  nitrogenous  or  animal  foods ;  sugar,  too,  is  much 
blamed  by  some.  It  seems  probable,  however,  that  so 
far  as  rheumatism  is  concerned,  it  is  mainly  such  articles 
of  diet  as  are  indigestible,  or  that  are  taken  in  excess, 
that  are  in  themselves  injurious.  For  we  find  rheumatic 
patients  in  all  classes,  and  perhaps  more  often  among 
those  where  actual  excess  is  not  very  common,  though 
dyspepsia  is  at  least  as  frequent.  Along  with  moderate 
living  we  must  also  have  regular  daily  exercise,  for  "  in 
the  sweat  of  thy  face  shalt  thou  eat  bread,  till  thou  return 
unto  the  ground,"  and  any  infraction  of  this  fiat  is  sooner 
or  later  injurious ;  the  sweat  glands  get  blocked,  effete 
material  accumulates  in  the  blood,  extra  work  is  thus 
thrown  upon  those  glands,  such  as  the  lungs  and  the 
kidneys,  by  which  the  system  throws  it  off.  The  whole 
art  of  warding  off  rheumatism,  then,  consists  in  leading 
as  natural  a  hfe  as  possible ;  living  moderately  in  a  freely 
ventilated,  properly  drained  house,  in  an  airy  situation, 
exposed  to  as  much  sunlight  as  possible,  and  keeping  all 
our  organs  in  good  working  order  by  regular  daily  exercise. 
Many  simple  inflammatory  affections  of  the  heart 
produce  results  very  similar  to  those  of  rheumatism ;  so 


86  THE   HEART   AND    ITS   FUNCTION. 

far  as  we  at  present  know,  this  is,  however,  but  seldom 
the  case,  and  when  they  do  occur  they  must  be  regarded 
as  simple  accidents,  and  wholly  unavoidable.  It  is  true 
that  there  are  some  who  look  upon  rheumatism  also  in 
this  light,  and  regard  it  merely  as  an  ordinary  inflam- 
mation of  the  fibrous  tissues,  but  there  are  many  indis- 
putable facts  both  in  regard  to  the  treatment  and  history 
of  the  disease  which  render  this  extremely  improbable, 
and  which  tend  to  confirm  the  ordinary  idea  of  its  being 
the  product  of  a  poison  of  a  distinctive  character. 

Hitherto,  the  forms  of  disease  referred  to  have  been 
such  as  are  more  or  less  strictly  limited  to  youthful  or 
early  adult  life,  and  in  them  the  heart  is  that  part  of  the 
circulating  system  primarily  affected ;  but  there  is  a  very 
important  series  of  diseases  which  are  strictly  senile  in 
character^  affecting  the  arteries  primarily,  and  the  heart 
only  secondarily.  These  diseases  are  of  the  most  variable 
character;  they  include  the  agonising  and  suffocative 
breast-pang,  every  form  of  valvular  lesion  of  the  heart, 
besides  diseases  of  the  kidney,  liver,  lungs,  brain,  and, 
indeed,  of  every  organ  of  the  body.  Diseases  which 
either  originate  directly  in  an  abnormal  condition  of  the 
arteries,  or  indirectly  through  the  secondary  disturbance  of 
the  heart's  function,  or  which  have  their  fatal  tendency 
impressed  on  them  by  that  imperfection  of  the  heart's 
function,  all  these  diseases  are  of  a  senile  character,  but 


THE   HEART  AND    ITS   FUNCTION.  Sj 

those  attacked  by  them  are  not  necessarily  old,  nor  are 
all  old  people  of  necessity  affected  by  them ;  quite  the 
contrary;  some  of  the  very  oldest  of  mankind — even 
those  who  have  overlived  one  hundred  years — have  been 
found,  after  death,  to  have  had  arteries  as  elastic  as  the 
youngest  and  healthiest  amongst  us,  and  their  great  age 
has  been,  with  apparent  truth,  attributed  to  this  cause. 
For  it  is  a  trite  but  true  axiom  that  a  man  is  never  any 
younger  than  his  arteries.  Whatever  his  actual  years 
may  be,  he  is  either  to  be  reckoned  young  or  old,  ac- 
cording as  his  arteries  are  youthful  and  elastic,  or  aged 
and  rigid ;  and  from  this  point  of  view  a  man  may  die  of 
extreme  old  age  long  before  he  has  exhausted  his  normal 
span  of  seventy  years.  How  important^  then,  it  must  be 
to  ward  off  this  senile  condition  of  the  arteries,  and  to 
maintain  their  youthful  elasticity  as  long  as  possible,  as, 
once  this  has  been  lost,  there  is  no  possible  restoration ; 
and  all  that  remains  is  to  put  on  the  drag  and  thus 
secure  that  the  descent  to  our  last  home  is  made  as  slowly 
and  gradually  as  possible.  Now  and  then  when  symptoms 
have  been  neglected,  and  the  descent  for  a  time  has  been 
unusually  rapid^  the  putting  on  of  the  drag  by  a  firm  and 
skilful  hand  has  all  the  seeming  effect  of  a  cure,  but  it  is 
both  foolish  and  unmanly  to  be  thus  deceived,  though  in 
the  prematurely  aged  it  is  perhaps  excusable. 

The  affection  of  the  arteries  which  gives  rise  to  all 


88  THE   HEART   AND    ITS    FUNCTION. 

these  changes,  and  which  thus  inaugurates  our  descent 
to  the  tomb,  may  be  called  by  the  comprehensive 
term  arterio-sclerosis.  This  term  means  simply  harden- 
ing of  the  arteries,  and  includes  every  change  from 
the  slightest  loss  of  elasticity  up  to  such  a  complete 
change  of  the  arterial  walls  that  they  feel  and  look  like 
branches  of  coral.  The  result  of  this  loss  of  elasticity 
of  the  arterial  walls  is  that  there  is  a  very  much  greater 
strain  thrown  upon  the  interior  of  the  ventricle,  that  is, 
the  left  ventricle,  for  it  is  only  the  aortic  system  that  is 
affected ;  the  result  of  this  is  dilatation  first  and  hyper- 
trophy afterwards,  in  fact  all  the  changes  which  are  com- 
prehensively included  in  the  term  gouty  heart.  At 
other  times  the  inflammatory  action  to  which  the  sclerosis 
is  due  invades  the  lining  membrane  of  the  heart,  and 
attacking  the  valves  may  produce  incompetency  of  these, 
and  all  the  secondary  results  which  flow  from  that.  The 
causes  of  this  premature  or  excessive  arterio-sclerosis  are 
partly  such  as  have  been  bequeathed  to  us  by  our 
ancestors,  and  partly  such  as  have  been  acquired  by 
ourselves.  Amongst  the  former,  or  those  bequeathed, 
syphilis  and  'gout  are  the  most  important,  and  of  these 
syphilis  ought  perhaps  to  be  considered  the  only  one 
positively  bequeathed,  as  in  these  circumstances  it  is 
strictly  congenital,  and  its  efi"ects  cannot  be  prevented 
from  occurring  by  any  care  on  our  part ;  while,  although 


THE   HEART   AND    ITS    FUNCTION.  89 

the  tendency  to  gout  is  congenital,  yet  its  manifestations 
may  be  largely,  if  not  altogether,  prevented  by  proper 
»  care.  Amongst  the  causes  of  arterio-sclerosis  which  may 
be  acquired  we  may  reckon  rheumatism,  chronic  alco- 
holism, syphilis,  gout,  lead  poisoning,  and  injury. 

Of  rheumatism  and  its  prevention  enough  has  already 
been  said,  and  we  need  not  recur  to  it ;  it  is  the  same 
disease  whether  it  gives  rise  to  an  endarteritis  or  an 
endocarditis,  and  though  affections  of  the  arteries  are 
not  so  common  from  this  cause  as  affections  of  the 
heart,  they  have  the  same  evil  habit  of  occurring  early 
in  life. 

Chronic  Alcoholism  is  also  a  frequent  cause  of 
arterio-sclerosis,  and  this  mainly  in  early  adult  life.  It 
is  believed  to  act  by  causing  strain  of  the  lining  mem- 
brane of  the  arteries  by  stimulating  both  the  arterioles 
and  the  heart  to  excessive  action.  This  of  course 
results  in  increase  of  the  intra-arterial  blood  pressure, 
as  the  heart  throws  the  blood  with  great  force  and 
rapidity  into  the  arteries,  while  the  arterioles  let  it 
escape  more  slowly,  hence  strain  and  injury  to  the 
elastic  middle  coat  of  the  arteries,  followed  by  chronic 
.  inflammation,  ending  in  arterio-sclerosis.  As  we  may 
readily  suppose,  the  abuse  of  alcohol  is  more  rapid  and 
certain  in  its  action  when  it  is  assisted  by  the  co- 
existence of  other  causes,  or  by  anything  which  of  itself 


90  THE    HEART   AND    ITS    FUNCTION. 

helps  to  raise  the  blood  pressure,  especially  when  acting  in 
this  abnormal  condition.  Hence  the  abuse  of  alcoholic 
drinks,  which  is  a  menace  to  the  health  in  various  ways 
as  well  as  in  this,  is  especially  dangerous  in  the  very 
circumstances  which  are  often  pleaded  as  an  excuse  for 
this  indulgence,  viz.,  where  there  is  need  for  continuous 
and  violent  exertion.  We  must  also  ever  remember  that 
occasional  acts  of  drunkenness,  however  disgusting  or 
degrading  in  themselves,  are  not  nearly  so  dangerous  to 
the  health  of  mankind  as  that  continual  saturation  of  the 
system  with  alcohol,  which  is  so  often  regarded  as  at  least 
a  venial  oiSence,  if  not  quite  up  to  the  highest  standard 
of  morality ;  and  we  must  also  remember  that  no  acci 
dental  instance  of  a  long  life  passed,  with  apparent  im- 
punity, in  a  constant  breach  of  the  law  of  temperance, 
is  of  any  value  as  a  proof  that  chronic  alcoholism  is  not 
a  dangerous  condition,  for  it  is  of  course  in  this,  as 
in  everything  else,  exceptions  that  prove  the  rule.  The 
abuse  of  alcohol  is  next  to  syphilis,  and  perhaps, 
quite  as  often  as  that  scourge  of  mankind,  one  of  the 
commonest  causes  of  heart  disease  from  early  senility 
of  the  arteries;  it  is  a  matter,  however,  which  is 
entirely  in  our  own  hands,  and  he  who  knowingly 
persists  in  his  vicious  habits,  after  fair  warning,  is  a 
suicide  of  the  worst  type.  Would  it  be  better  for  us  all 
therefore  to  be  teetotallers  ?  is  a  question  which  may  be 


THE    HEART  AND    ITS    FUNCTION.  9 1 

very  pertinently  asked ;  it  is  one,  however,  which  is  not 
so  easily  answered,  because  it  seems  very  unlikely  |hat 
alcohol  should  be  so  widespread,  so  easily  obtained,  and 
so  constantly  imbibed  in  one  form  or  other  by  all  classes 
and  all  races  of  men  if  it  did  not  serve  some  good  end  in 
the  economy  of  nature.  Moreover,  it  would  almost  seem 
as  if  the  depressing  influences  of  our  present  civilisation, 
such  as  the  overcrowding  of  our  large  cities,  &c.,  gave 
rise  to  such  a  weakly  habit  of  body  in  many  as  almost  to 
necessitate  the  daily  use  of  a  certain  amount  of  alcoholic 
fluid.  For  these,  as  well  as  for  all,  the  Christian  rule  of 
"  let  your  moderation  be  known  of  all  men,"  seems  to  be 
a  very  much  safer,  as  well  as  a  much  higher,  standard  of 
morality  than  any  teetotal  dogma. 

Syphilis  is  a  matter  much  more  easily  disposed  of; 
probably  it  is  the  most  common  cause  of  by  far  the  larger 
proportion  of  diseases  which  shorten  life,  arterio-sclerosis 
among  them,  but  absolute  prevention  is  the  only  cure. 
Once  contracted,  it  pervades  the  system  through  all  time, 
and  affects  generations  yet  unborn  ;  much  may  be  done 
for  it  by  appropriate  medical  treatment,  its  outbreaks 
may  be  shortened  and  it  may  be  kept  in  abeyance,  but  it 
is  never  cured,  and  it  may  break  out  at  any  moment 
For  congenital  syphilis  there  is- no  perfect  cure;  it  is 
believed  to  die  out  in  the  course  of  successive  genera- 
tions, it  is  to  be  hoped  it  may  in  some  cases  do  so; 


92  THE    HEART   AND    ITS    FUNCTION. 

but  as  a  rule  it  is  the  victims  which  die  out  and  not  the 
disease. 

Gout  belongs  very  much  to  the  same  category  as 
rheumatism ;  it,  too,  is  a  sewage  poison,  but  the  accumu- 
lation of  the  effete  and  injurious  material  is  not  in  the  air 
around  us,  but  within  us,  in  our  blood.  It  is  a  disease 
of  civilisation,  and  appears  to  be  largely,  but  probably 
not  altogether,  due  to  excess  in  food  and  drink  above  the 
wants  of  the  body,  and  to  deficient  exercise.  It  is  not, 
now-a-days  at  least,  confined  to  the  upper  ten  thousand, 
if  it  ever  was  so.  Sydenham  flattered  himself  that  he 
suffered  in  common  with  kings,  men  of  illustrious  rank, 
and  philosophers,  and  that  his  disease  had  killed  more 
rich  men  than  poor,  more  wise  men  than  fools.  This  is 
but  a  poor  consolation,  especially  when  coupled  with  the 
fact  that  his  sufferings  were,  as  we  now  know,  shared  by 
coalheavers  and  the  lowest  scum  of  the  earth.  Perhaps 
there  were  no  such  people  in  his  day ;  more  probably  he 
was  only  ignorant  of  their  diseases.  Moderate  living  and 
abundant  exercise  have  long  been  known  as  the  best  pre- 
ventives of  gout ;  to  live  upon  sixpence  a  day,  and  earn 
it,  has  been  said  to  be  the  best  cure;  and  there  is  no 
little  truth  in  the  statement.  The  late  Dr.  Gairdner,  of 
London,  in  his  interesting  work  on  Gout,  relates  that 
Dr.  Gregory,  of  Edinburgh,  struck  by  the  serious  suffer- 
ings he  had  witnessed  among  his  relatives,  resolved,  at 


THE    HEART   AND    ITS    FUNCTION.  93 

an  early  period  of  life,  to  subdue  the  tendency  to  the 
disease  in  himself  He  prescribed  to  himself  a  frugal  diet, 
with  much  bodily  exercise,  and  by  strict"  adherence  to 
these  rules  he  attained  his  object  of  being  the  first  indi- 
vidual of  his  family  who  lived  and  died  free  from  gout.  In 
the  same  author  we  also  find  the  following  instance  of  a 
cure  : — "  A  gentleman  of  the  Stock  Exchange  suffered  so 
much  from  gout  as  to  become  quite  a  cripple.  He  was 
seldom  seen  but  wrapped  in  flannel  at  his  chimney 
corner,  where,  notwithstanding,  he  retained  great  cheer- 
fulness of  character.  He  was  overtaken  by  one  of  those 
great  reverses  of  fortune  to  which  persons  in  his  profes- 
sion are  so  much  exposed.  Compelled  by  necessity,  and 
assisted  by  abstinence,  he  returned  to  business,  and  sur- 
prised his  friends  by  becoming  once  more  one  of  those 
hurried  and  nimble  individuals  so  well  known  to  all  men 
who  frequent  the  city."  It  would  be  vain  to  expect  such 
cures  to  be  frequent ;  the  prevention  of  gout  is  more 
easily  attainable,  and  in  carrying  out  the  necessary 
regimen  it  is  important  to  remember  that  the  skin,  the 
kidneys,  and  the  lungs  are  the  natural  emunctories  of  the 
body,  from  which  the  waste  materials  of  our  bodies 
escape ;  the  bowels,  which  most  people  are  so  anxious 
about,  being  really  of  comparatively  trifling  import- 
ance, because  their  contents  are  mainly  the  refuse  of 
our  food,  and  contain  but  little  of  the  waste  products 


94  THE   HEART   AND    ITS    FUNCTION. 

resulting  from  those  transformations  of  energy  which 
manifest  our  vitality,  and  which  in  many  ways  act  as 
poisons. 

Injury  is  a  source  of  arterial  disease,  and  through  that 
of  the  heart,  none  of  us  can  escape,  should  it  come  in  our 
way  ;  but  the  injury  due  to  over-violent  exertion  we  have 
entirely  in  our  own  hands,  and  every  one  is  responsible  to 
himself  for  any  dereliction  of  duty  in  respect  of  exercise, 
in  which  excess  may  be  more  immediately,  but  is  not  less 
certainly,  dangerous,  than  defect. 

The  Clothing  and  Accoutrements  of  soldiers,  espe- 
cially in  conjunction  with  the  violent  exertion  to  which 
they  are  so  frequently  exposed  in  forced  marches,  &c., 
have  often  been  blamed  as  a  fruitful  source  of  heart  disease 
in  the  army,  and  doubtless  with  good  reason ;  yet  there  is 
no  reasonable  doubt  that  the  prevalence  of  syphilis  and 
chronic  alcoholism  has  at  least  doubled  the  sad  tale  of 
preventable  cardiac  mischief.  In  civil  life  the  clothing 
can  rarely  be  blamed,  but  it  is  right  to  remember  that 
whatever  restrains  the  movements  of  the  chest,  or  of  the 
limbs,  or  impedes  the  free  passage  of  the  blood  from 
one  part  of  the  body  to  another,  must  necessarily  throw 
an  extra  strain  upon  the  heart,  which  may  result  in 
disease,  and  must  certainly  largely  augment  the  evil 
resulting  from  any  other  injurious  influences  which  may . 
coexist. 


THE    HEART    AND    ITS    FUNCTION.  95 

From  what  has  been  said,  it  is  evident  that  mankind 
Ijave  a  great  deal  in  their  own  power  in  the  way  of  pre- 
venting any  disturbance  of  the  heart's  function,  while  the 
necessary  measures  are  all  of  such  a  kind  as  must  of 
necessity  improve  their  health,  increase  their  mental 
energy,  aftd  lengthen  tlieir  lives. 


THE    END. 


HEALTH  PRIMERS: 

A  Series  of  Hand-books  on  Personal  and  Private  Hygiene. 

EDITED   BY 

J.  LANGDON  DOWN,  M.D.,  F.R.  C.P. 
HENR  T  PO  WEB,  M.  D. ,  F.  R.  C.  S. 
J.  MORTIMER-QRANVILLE,  M.D. 
JOHN  TWEEDY,  F.R.  C.S. 

It  is  notorious  that  most  of  the  cheap  and  popular  books  on  health  are  mere 
crude  compilations  of  incompetent  persons,  and  are  often  misleading  and  inju- 
rious. Impressed  by  these  considerations,  several  eminent  medical  and  scien- 
tific men  of  London  have  combined  to  prepare  a  series  of  Health  Peimeks  of  a 
character  that  shall  be  entitled  to  the  fullest  confidence.  Each  Primer  will  be 
written  by  a  gentleman  specially  competent  to  treat  his  subject. 

These  little  books  are  produced  by  English  authors,  but,  since  the  essential 
conditions  of  avoiding  disease  and  preserving  health  are  to  a  great  degee  every- 
where the  same,  they  will  prove  of  the  utmost  benefit  wherever  their  language 
is  spoken. 

NOW   READY: 

ExEKOiSE  AND  Tkainikg.     By  C.  n. 

Ealfe,  M.  D. 
Alcohol  :  Its  Use  and  Abuse.    By  W. 

8.  Greenfield,  M.  D. 
Baths  and  Bathing. 
The  Skin  and  its  Troubles. 
The  House  and  its  Surroundings. 


Premature    Death:    Its    Promotion 

and  Prevention. 
Personal  Appearances  in  Health 

AND  Disease.     By  S.  Coupland, 

M.D. 
The  Heart  and  its  Function. 


The  Nerves. 

The  Ear  and  Hearing. 

The  Head. 

Clothing  and  Dress. 

Water. 

Fatigue  and  Pain. 

The  Throat  and  Voice. 


TO   BE    FOLLOWED   BY: 

Tempkratuee   in  Health  and  Dis- 
ease. 
Health  of  Travelers. 
Health  in  Schools. 
The  Ete  and  Vision. 
Breath  Organs. 
Foods  and.  Feeding. 


AND   other  volumes. 

In  square  l6mo  volumes,  cloth,  price,  40  cents  each. 


For  sale  by  all  booksellers.    Any  volume  mailed,  post-paid,  to  any  address  in 
the  United  States,  on  receipt  of  price. 


D.  APPLETON  &  CO.,  Publishers,  1,  3,  «&  5  Bond  Street,  New  York. 


HEALTH, 


AND 


HOW    TO    PROMOTE    IT. 

By  RICHARD  McSHERRY,  M.  0., 

Frofessor  of  Principles  and  Practice  of  Medicine,  University  of  Maryland; 

^leinber  of  American  Medical  Association ;  Pi-esident  of 

Baltimore  Academy  of  Medicine. 


"  Hygiene,  public  and  private,  has  become,  of  late  years,  one  of  the  most  im- 
portant elements  of  modern  civilization.  It  is  a  subject  in  which  all  mankind 
has  an  interest,  even  if  it  be,  as  it  too  often  is,  an  unconscious  interest. 

"The  present  work  is  addressed  to  the  general  reader,  no  irjatter  what  his 
pursuit,  and  the  language  is  such  as  any  f>hysician  may  use  in  conversation  with 
an  intelligent  patient;  it  is  therefore  as  free  as  such  a  woi-k  can  be  made  from 
scientific  technicalities. 

*'  It  is  offered  as  a  contribution  to  a  great  cause,  and  the  writer  trusts  that  it 
will  have  some  influence  in  promoting  the  health,  happiness,  and  welfare  of  all 
who  may  honor  it  mth  a  careful  perusal.  The  principles  advocated  have  been, 
to  a  great  extent,  put  in  practice  in  the  personal  experience  of  the  winter  in 
various  parts  of  the  world,  and  under  many  vicissitudes,  and  he  has  found  them 
to  be  not  vague  theories,  but  practical  truths  of  the  greatest  importance."— JSr- 
tract  from  Preface. 

OOKTTElSrTS. 
PART  I.— INTRODUCTORY  REMARKS. 
Ilyiene  the  Better  Part  of  Medicine.— The  Four  Divisions  of  Human  Life;  The 
First  Quarter,  or  the  First  Score  of  Tears.    The  Young  Man ;  the  Young 
Woman.    The  Man ;  the  Woman.    The  Declining  or  Old  Man. 

PART  II.— HYGIENICS  IN  SOME  DETAIL. 
Ilace.  Temperaments,  and  Idiosyncrasies.— Inheritance.— Habit.- Constitution. 
—The  Air  we  Breathe.— Sewers  and  Cesspools.-Ozone.— Malaria.— Animal 
Emanations.  —  Devitalized  IIouse-Air.  —  Water.  —  Clothing.  —  Exercise  or 
Work.— Influence  of  Occupation  upon  Longevity.— Limit  to  Labor.— The 
Food  of  Man.— Accessory  Food.-Manner  of  Eating.- Tea  and  Coffee.— Al- 
cohol.—Use  and  Abuse.— Ardent  Spirits.— Wines.— Malt  Liquors.— Tobacco. 
—Chewing  and  Smoking  should  be  forbidden  in  School.— Report  of  Naval 
Surgeons. 

One  volume,  12mo,    Cloth.     Price,  $1.23. 

IJ.  APPLET  ON  .fc  CO.,  Publishers,  1,  3,  tfe  5  Bond  Street,  New  York. 


COLUMBIA  UNIVERSITY 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 


DATE   BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

i^^      '     ^   ^' 

J 

NOV      , 

i  19451 

■    -m  4 

1948 

(jiv   ■■ 

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The  heart  and  its  function 


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